上颌窦内窥镜在眶底骨折诊断中的应用。

The use of maxillary sinus endoscopy in the diagnosis of orbital floor fractures.

作者信息

Sandler N A, Carrau R L, Ochs M W, Beatty R L

机构信息

Department of Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, PA, USA.

出版信息

J Oral Maxillofac Surg. 1999 Apr;57(4):399-403. doi: 10.1016/s0278-2391(99)90278-1.

DOI:10.1016/s0278-2391(99)90278-1

PMID:10199491

Abstract

PURPOSE

The goal of the current study was to evaluate the ability to diagnose the presence of an inferior orbital wall fracture through the use of a transantral endoscopy technique at bedside.

PATIENTS AND METHODS

Seven trauma patients with initial axial computed tomography (CT) scan findings consistent with an orbital floor fracture were studied. Before endoscopy, the patients underwent a coronal CT scan with 3-mm cuts for later comparison with the endoscopic findings. The surgeon performing the endoscopy procedure was blinded to the results of the coronal CT scan. Visual acuity, intraocular pressure, and measurement for enophthalmos were performed before endoscopy. The endoscopic procedure was performed at the bedside using local anesthesia. A trocar was used in the canine fossa to gain access to the maxillary sinus. A 30 degrees and then a 70 degrees endoscope were introduced through the trocar to evaluate the integrity of the orbital floor (ie, maxillary sinus roof). The degree of mucosal injury of the orbital floor and the presence of blood or orbital contents in the sinus were recorded. The ophthalmologic examination was repeated after completion of endoscopy.

RESULTS

The endoscopic procedure was able to be completed in all patients. There was no change in the ophthalmologic examination in any patient as a result of endoscopy. In six of the seven patients studied, the endoscopic findings correlated with the need for surgical intervention to repair the orbital floor predicted on the basis of coronal CT scan. This was determined by the degree of injury to the orbital floor and the presence of hematoma, exposed bone, or fat. In the remaining case, endoscopy was not diagnostic for the presence of a fracture because only ecchymosis of the orbital floor was noted.

CONCLUSIONS

The ability to perform endoscopy under local anesthesia at the bedside is useful in those trauma patients whose concomitant injuries may prohibit other diagnostic modalities.

摘要

目的

本研究的目的是评估在床边使用经窦内镜技术诊断眶下壁骨折的能力。

患者与方法

对7例初始轴向计算机断层扫描（CT）结果与眶底骨折相符的创伤患者进行了研究。在内镜检查前，患者接受了层厚3毫米的冠状位CT扫描，以便随后与内镜检查结果进行比较。进行内镜检查的外科医生对冠状位CT扫描结果不知情。在内镜检查前测量了视力、眼压并评估了眼球内陷情况。在内镜检查床边使用局部麻醉进行操作。使用套管针经尖牙窝进入上颌窦。通过套管针先后插入30度和70度的内镜，以评估眶底（即上颌窦顶）的完整性。记录眶底黏膜损伤程度以及窦腔内血液或眶内容物的情况。内镜检查完成后重复进行眼科检查。