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In recent years, endoscope-assisted balloon fixation using transantral and endonasal approaches has gained popularity as a minimally invasive treatment for orbital floor fractures. However, the optimal duration for balloon placement and the efficacy of the method have not been fully evaluated. The authors report their assessment of this method using postoperative and chronological measurements of the maxillary sinus volume.Fourteen patients with blowout fracture of the orbital floor who underwent reduction using endoscopic transantral and endonasal approaches followed by 6-week fixation with a balloon were evaluated. The volume of the maxillary sinus was measured for comparison using computed tomography at the time of balloon removal and 6 months after the surgery.The ratio of change in the maxillary sinus volume (maxillary sinus volume 6 months after surgery/maxillary sinus volume at balloon removal) for all subjects was 0.90 to 1.04 (0.96 ± 0.44, mean ± SD). No postoperative reduction in volume was detected, indicating satisfactory fixation. Postoperative computed tomography showed bone regeneration in the orbital floor in all patients in whom the fractured bone fragments were removed. No subjects had remaining enophthalmos greater than 2 mm.The postoperative change in the maxillary sinus volume was small, confirming the efficacy of 6-week balloon placement. This method was effective even in patients in whom fractured bone fragments were removed. Therefore, it is advisable to remove the fractured bone fragments if there is concern that the fragments will stray into the orbit due to inflation of the balloon.