Minimally Invasive Endoscopic Transorbital Approach for Frontal Sinus Fractures: A Comparative Study

Background: This study aims to evaluate the use of the endoscopic transorbital approach for reducing frontal sinus fractures and compare its outcomes with the traditional bicoronal approach. Methods: A retrospective comparative analysis of case studies including all patients with frontal sinus fractures treated at our institution between January 2013 and December 2023 was conducted. Patients were categorized based on treatment approach (through traumatic laceration, bicoronal, or endoscopic transorbital). For the comparative analysis, cases with associated maxillofacial fractures or cerebrospinal fluid (CSF) leakage were excluded. Results: Out of 133 patients, 35 underwent surgery, with 6 patients treated using the endoscopic transorbital approach. This group of patients treated with the transorbital endoscopic approach demonstrated significantly shorter operative times compared to the bicoronal approach (mean 102 vs. 168 min, p = 0.021). They also had only minor complications, including temporary hypoesthesia and one transient ptosis. One patient had a minimal residual defect. The technique has been concluded to require endoscopic expertise. Conclusions: The endoscopic transorbital approach is a safe, minimally invasive alternative to the bicoronal approach for selected anterior wall frontal sinus fractures. Proper patient selection and surgical experience are essential to achieving favorable outcomes. Studies with longer follow-up are required to assess potential late complications, such as the development of mucoceles.