Purpose To study the suitability of an endoscopic transcaruncular approach (ETA) for repair of large medial orbital wall fractures (MOWFs) near the orbital apex.

Design  A retrospective, non-comparative case series with describing a surgical technique.

Participants  Ninty-three consecutive patients (93 orbits) with large isolated MOWFs near the orbital apex.

Patients and methods The isolated MOWFs were determined by computed tomographic (CT) scans of the orbit in all patients. All patients underwent fracture repair by an ETA and the size of the vertical and longitudinal defects was measured during surgeries. Thin Medpor sheets (1.0mmthick) were used to repair the bony defects. Patients were followed up for 6 to 15 months.

Main outcome measures: Size of vertical and longitudinal fracture defects, rate of complete repair of the fracture defects, and correction of enophthalmos, resolution of diplopia and complications 6 months after surgery.

Results All surgeries were completed uneventfully. The mean postoperative follow-up time was 9.7±3.0 months. Under direct endoscopic visualization, all entrapped and inherniated orbital contents were released and reposited, the entire boundary of the fractures were adequately exposed and the Medpor sheets placed to stably overlie all edges of the fracture in all cases. The vertical and longitudinal fracture defects measured during surgeries ranged from 16 to30 mmand from 25 to34 mm, respectively. Six months after surgery, complete reconstruction of the bony defects was demonstrated by the orbital CT scans and good symmetry of the both eye was acquired in 92 of 93 patients (98.9%). Of 30 patients with preoperative significant enophthalmos greater than2 mm, 29 (96.7%) were corrected, with a mean improvement of 3.37 +/- 0.77 mm; Diplopia within 30° visual field of the gaze was resolved in 40 of 43 (93.0%) patients; Three patients (7.0%) had residual diplopia on medial gaze due to presumed paralysis of the medial rectus muscle. Intraorbital hemorrhage occurred in one patient the day after surgery and resolved with conservative treatment.

Conclusions The ETA appears to be an ideal method for recovery of the normal anatomic characteristics of the orbital for patients with large MOWFs near the orbital apex.