Correction of Late Posttraumatic Enophthalmos Using an Antral Balloon Masanobu Yamashita, MD, Haruhisa Daizo, MD, Akiko Yamashita, MD, Miyuki Kishibe, MD, and Kenichi Shimada, MD Abstract: Enophthalmos is the posterior displacement of the ocular globe within the bony orbit. Correction of late posttraumatic enophthalmos is one of the most challenging surgical procedures. We have performed a corrective procedure for late enophthalmos using an antral balloon, with or without minimal bone grafting. All orbital contents were separated from the bone fragments, infraorbital nerve, and mucosa of the maxillary antrum. The remaining orbital floor was fractured by the surgeon’s digital pressure from the maxillary antrum. The antral balloon was placed in the maxillary antrum and inflated under direct vision from inside the orbit. After a consolidation period, the patient underwent antral balloon removal. A total of 5 patients underwent repair of late enophthalmos using this antral balloon technique. The median time from initial injury was 14 months (range, 6–90 months). The median antral balloon placement duration was 76 days (range, 53–106 days). Satisfactory symmetries were achieved in 4 patients. Mild residual enophthalmos remained in 1 patient, who had an orbital framework deformity and was missing the entire orbital bony floor preoperatively and who required simultaneous bone grafting. The ideal indication for our technique was the need for orbital floor reconstruction, without an orbital framework deformity. This technique could avoid autogenous bone grafting or permanent alloplastic implantation, which may cause a foreign body reaction, chronic inflammation, and migration. We believe that our new technique is one of the least invasive corrective procedures for late posttraumatic enophthalmos.

the acute treatment of orbital floor fractures with resulting enophthalmos. By contrast, midfacial trauma that is not treated acutely, or surgical cases with inadequate reduction and/or inadequate bone grafting, can lead to late posttraumatic enophthal-

Key Words: Antral balloon, bone graft, enophthalmos, facial injury, orbital fracture (J Craniofac Surg 2015;26: 1365–1369)

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nophthalmos is the posterior displacement of the ocular globe within the bony orbit. It is a common sequela of midfacial fractures. Two to 3 mm of enophthalmos is clinically detectable, and more than 5 mm is disfiguring.1 Generally, acute midfacial fractures are treated by reduction, internal rigid fixation, and primary bone grafting within a couple of weeks of the initial injury.2 The antral balloon technique is a useful alternative for

Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.