The Endoscope-Assisted Surgery of the Traumatized Midface

Introduction: Many different approaches to the fractured midface have been described. In 1999, Forrest introduced an endoscope-assisted minimally invasive transantral technique to the orbit with good aesthetic and functional results. The aim of the present study was to examine the results of a modified minimally invasive endoscopic approach to different fractures of the midface and skull base concerning functional and aesthetic recovery.

Methods: Between 2004 and 2006 at the Department of Oral and Maxillofacial Surgery in Schwerin, 35 successive patients with a fracture of the orbital floor, the zygoma, and the frontal sinuses were treated using this modified Forrest technique. All patients were surveyed using pre- and postoperative CT and photographic documentation of the clinical aspect. The orbit and the zygoma were exposed by a transoral approach, the frontal sinuses using small cuts in the eyebrow and behind the hairline. Pre- and postoperative complaints, complications, and time of hospitalization were compared.

Results: Postoperatively only 3 patients had transient hematoma and/or inflammation. Revision surgery was not necessary. The modified minimally invasive endoscope-assisted technique, on the other hand, allowed wide exposure of the fractures without additional trauma. The possibility of early intervention reduced morbidity and rendered good aesthetic and functional results.

Conclusion: The minimally invasive endoscope-assisted treatment of fractures of the midface allows well-controlled reposition without additional trauma and with good functional and aesthetic impairment.