LAUSR

CLINICAL REPORT A 66-year-old female stumbled, fell, and hit her right eye against a cupboard, after which she experienced diplopia in all directions of eye movement. She had diabetes mellitus that was poorly controlled but did not have symptoms for orthostatic hypotension. She did not have a previous history of paranasal sinusitis. During the first examination, 1 day after the injury, the patient could not attain binocular single vision in any eye position as extraocular muscle motility in the right eye was severely restricted in all directions. Computed tomographic images revealed fractures of the medial orbital wall with orbital fat prolapse into the nasal cavity (Fig. 1A). The fracture reached the level just posterior to the origin of Horner’s muscle anteriorly, the level parallel to the posterior ethmoidal artery posteriorly, the frontoethmoidal suture superiorly, and the junction between the orbital wall and orbital strut inferiorly. The right medial rectus muscle showed a large deviation from its normal location. After glycemic control, the fractures were reduced using transcaruncular and endoscopic endonasal approaches 11 days after the injury. An expanded polytetrafluoroethylene (Gore-Tex; Japan Gore Inc, Tokyo, Japan) sheet was implanted because this is easy available, foldable during insertion through a small surgical space, and there is no need for a second surgical site to harvest a bone graft. The size of the Gore-Tex sheet was enough to completely cover the fracture site. A hydroxyapatite/poly-L-lactic acid plate (Super Fixsorb MX; TEIJIN Medical Technologies Co, Ltd, Osaka, Japan) was also inserted to support the Gore-Tex sheet without dislocation of the sheet into the ethmoid sinus. Postoperatively, we administered intravenous antibiotics for 10 days as prophylaxis for surgical site infection and postoperative fever, in consideration of her diabetic status. Eight months after the surgery, her diplopia disappeared and she attained an acceptable binocular single vision field (Fig. 1B).