## 4 Discussion
Our 3D digital analysis showed that the discrepancy between the mirrored image of the untreated and the treated orbit was generally always greater in Group A, with higher values recorded in the most posterior points of reference. This event probably indicated that the surgical procedure of the anteroposterior ethmoidectomy allows for a better view of the posterior portion of the medial orbital wall, thus confirming a more precise fracture reduction. The second comparation, immediate postoperative versus 6 months, showed how, despite the anteroposterior ethmoidectomy, stability results are comparable between the two groups, without particular trends between the three zones. The most valuable benefit of the APE resides in the complete exposition of the lamina papyracea that grants a wider domination of the fracture, even in the more anterior cases. As suggested by the 3D analysis, reduction was more stable in the long term with a minimal displacement. Considering the length of hospitalization, we did not observe a clear difference between the two groups: a mildly longer hospitalization, ranging from +1 and +2 days, was observed \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Author** & **Year** & **Approach** & **Surgical Technique** & **Implants** \\ \hline [PERSON] et al. [10] & 2009 & EE & UC, BC, AE & Silastic sheet \\ \hline [PERSON] & & & & \\ et al. [14] & 2010 & EE & UC, BC, AE & Silastic sheet \\ \hline [PERSON] et al. [17] & 2015 & RCa, EAs & ORIF & Titanium mesh \\ \hline [PERSON] et al. [8] & 2015 & EE & UC, BC, AE/APE & Silastic sheet \\ \hline [PERSON] et al. [22] & 2015 & EE/SP & ORIF & Medpor sheet \\ \hline [PERSON] et al. [3] & 2016 & EE & APE & Medpor sheet \\ \hline [PERSON] et al. [4] & 2016 & EE & UC, BC, APE & Medpor sheet \\ \hline [PERSON] et al. [18] & 2016 & EE & UC, MSA, BC, APE & \begin{tabular}{c} Dura mater \\ substitutes, \\ Medpore \\ \end{tabular} \\ \hline [PERSON] & & & & \\ et al. [10] & 2019 & EE & pMTT, AE & \begin{tabular}{c} Titanium mesh \\ with Medpor \\ \end{tabular} \\ \hline Bonsembiante & & & & \\ et al. [20] & 2019 & EE & UC, AE & \
\begin{tabular}{c} Medpor with \\ fibrin glue, \\ Endonasal splint \\ \end{tabular} \\ \hline [PERSON] et al. [21] & 2019 & TCa & ORIF &
\begin{tabular}{c} Unsitered \\ Hydroxyapatite \\ Particle/Poly \\ L-lactide sheet \\ \end{tabular} \\ \hline [PERSON] et al. [16] & 2020 & EE vs TCa & UC, MSA, AE, MTL & Synpor sheet \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Most recent literature regarding the surgical procedure of medial orbital wall fracture reduction. Approach: EE—endosome endonasal; EAs—endoscopic assistance; RCa—retrocaruncular; TCA—transarcurucular; PCa—precaruncular; SP—subpalpebral; TC—tranconginuval. Surgical Technique: UC—uncinectomy, MSA—maximillary sinus anntrostomy, BC—bullectomy, AE—antierophorectomy, APE—antieroposterior ethmoidectomy, pMT—middle turbinate turbinectomy, MTT—middle turbinate luxation, ORIF—open reduction, internal fixation. in Group B, due to the removal of the splint on the fourth/fifth day. For these reasons, the institutional cost of both procedure is comparable. This study aimed to investigate the best surgical procedure by which to treat medial orbital wall fractures by an endoscopic only approach, with a focus on the peculiarity of the surgical technique and the encountered anatomy. The evaluation performed included only objective analysis, such as clinical presentation and 3D analysis. Further studies on a larger scale are necessary and should also include a procedure comparison that assesses patient-related status and satisfaction. The limitations of our study can be summarized by the following: sample size of the population; single-center investigation; difficult reproducibility of the study due to the adoption of software requiring long learning curve. Our technique demonstrates how the endoscopic approach represents a safe and standardized procedure for the reduction of orbital medial wall fractures.