Baumann A, Ewers R
Clinic of Oral and Maxillofacial Surgery, Medical School, University of Vienna, Austria.
Int J Oral Maxillofac Surg. 2000 Aug;29(4):264-7.
Medial orbital wall fractures can cause horizontal diplopia and enophthalmos. Therefore, reconstruction of displaced medial wall fractures should be considered. We used a transcaruncular approach in five male patients to reconstruct the medial orbital wall after acute injuries and also as a secondary procedure for enophthalmos correction. Four of these patients had a concomitant orbital floor fracture. The incision was made in the caruncule and extended in the conjunctiva superior and inferior into the fornices for 10-12 mm. The tissue was bluntly dissected in an anteroposterior direction. The periosteum was incised dorsal of the posterior lacrimal crest and after elevation of the periosteum, the fractured orbital wall was visible. Transplants up to a height of 2 cm could be inserted for reconstruction of the medial orbital wall. In the cases of acute trauma, the medial wall was reconstructed using a resorbable polydioxanone plate. Cortical bone was used for the reconstruction of late enophthalmos. No postoperative complications were found. The transcaruncular approach gave a rapid entry to the fractured medial orbital wall without a visible scar.
眶内侧壁骨折可导致水平性复视和眼球内陷。因此，应考虑对移位的内侧壁骨折进行重建。我们对5例男性患者采用经泪阜入路，在急性损伤后重建眶内侧壁，也作为矫正眼球内陷的二期手术。其中4例患者合并眶底骨折。切口在泪阜处，向上、下延伸至结膜穹窿10 - 12毫米。组织沿前后方向钝性分离。在泪后嵴背侧切开骨膜，掀起骨膜后可见骨折的眶壁。可插入高达2厘米的移植物用于重建眶内侧壁。在急性创伤病例中，使用可吸收的聚二氧六环酮板重建内侧壁。晚期眼球内陷则使用皮质骨进行重建。未发现术后并发症。经泪阜入路可快速进入骨折的眶内侧壁，且无明显瘢痕。
