Minimally invasive surgery helps patients with facial fractures

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St. Joseph’s Health Care London is expanding its expertise in minimally invasive surgery to include procedures that treat patients with maxillofacial trauma. Dr. Corey Moore, a subspecialist in facial plastic and reconstructive surgery, is currently treating selected facial fractures with minimally invasive techniques using small endoscopes and micro instruments to reset facial fractures. Fractures treated with this endoscopic technique so far include orbital fractures and mandible fractures.

Often times with this minimally invasive technique, the surgery is much easier on patients, with smaller incisions, less operating room time and decreased time spent in hospital.

Dr. Moore, who originally trained in Otorhinolaryngology -Head and Neck Surgery and then did further training in Facial Plastic Surgery – uses a lot of endoscopic sinus instruments to treat these fractures. Because this technique is so new, companies have not had a chance to develop instruments specifically designed for particular surgeries. He uses an endoscopic forehead lift set to repair jaw fractures and a sinus set for orbital fractures. The hospital has just approved the purchase of an endoscopic jaw fracture set designed specifically for those types of fractures.

Dr. Moore recently performed the first transnasal (through the nose) endoscopic repair of a medial orbital blow out fracture in Canada. The young man, who was playing basketball at the University of Waterloo and was hit in the eye, sustained a large medial wall blow out fracture of his left eye.ÊIf not repaired, the fracture would have left him with permanent double vision.

The original surgery was planned outside of London, to approach the particular fracture by a coronal approach with a cranial bone graft repair. This involves making a large scalping incision from ear to ear and taking a bone graft from the outer skull to use to patch the defect.ÊAfter hearing this the patient wanted a second opinion and was referred to Dr. Moore for assessment for endoscopic fixation.

The young man had significant diplopia (double vision) with enophthalmous (sinking of the eyeball into the orbit). This type of fracture would have to be repaired and, due to the size of it, the usual surgery is quite extensive and long, usually four to six hours.

Dr. Moore performed his endoscopic repair with an operating room time of half an hour. The patient sustained no incision or scar and was out of hospital in one day. His double vision was improved immediately.

The technique is quite simple, given knowledge of nasal anatomy. The wall of the medial orbit was fractured into the nasal sinuses. Dr. Moore identified the bone through endoscopic technique, and placed it back into position using a foley catheter inflated inside the nose. This was left in place for three weeks to support the fractured bone.

The technique can only be used for certain fractures, and not all fractures can be fixed with the minimally invasive technique. In this case, it saved the patient a long extensive surgery, which would have meant a hospital stay of a few days.