Haug Richard H, Van Sickels Joseph E, Jenkins William S
Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY 40536-0297, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Mar;93(3):238-46. doi: 10.1067/moe.2002.120975.
The purpose of this article was to review the frequency, germane anatomy, management modalities, and complications associated with the treatment of orbital roof fractures in the pediatric and the adult population.
A review of the past 30 years of the English-language maxillofacial surgical literature was undertaken. Important concepts were coupled with the authors' experience to provide a synopsis of contemporary thought on this topic.
More than 235 articles in the oral and maxillofacial, plastic and reconstructive, otolaryngology-head and neck, ophthalmologic, oculoplastic, neurologic, and pediatric surgical literature were reviewed and assessed. From this group, 50 articles were found to contain useful information.
It has been estimated that 1% to 9% of all facial fractures involve the orbital roof. The typical adult with an orbital roof fracture is a man (89%-93%) who has been involved in a high-energy impact and who has sustained concomitant multisystem injuries (57%-77%). Orbital roof fractures most commonly coexist with other craniofacial injuries. In contrast, in pediatric patients with an orbital roof injury, we see nearly equal sex distribution; the typical patient in this case has a frontobasal fracture that is minimally displaced or nondisplaced (53%-93%) and has sustained concomitant multisystem injuries. The pediatric patient is usually managed by means of observation alone (53%-86%). For the adult patient, a subcranial approach to the orbital roof by means of a bitemporal flap or superior blepharoplasty incision offers wide access with minimal morbidity. Currently available titanium microscrew and miniscrew and mesh systems offer a near-ideal modality for orbital roof reconstruction. The coexisting neurocranial, frontal sinus, and supraorbital rim fractures take priority over the management of orbital roof fractures. Complications associated with orbital roof injuries can be categorized as those attributed to the following: concomitant injury, surgical access, postreconstruction volume discrepancy, muscle entrapment, hemorrhage, and/or infection.
本文旨在回顾小儿及成人眶顶骨折治疗的发生频率、相关解剖结构、处理方式及并发症。
对过去30年的英文颌面外科文献进行回顾。重要概念结合作者经验，以提供该主题当代观点的概述。
对口腔颌面、整形与重建、耳鼻咽喉 - 头颈、眼科、眼整形、神经及小儿外科文献中的235篇以上文章进行了回顾和评估。从中发现50篇文章包含有用信息。
据估计，所有面部骨折中1%至9%累及眶顶。典型的成年眶顶骨折患者为男性（89% - 93%），遭受高能撞击，伴有多系统损伤（57% - 77%）。眶顶骨折最常与其他颅面损伤并存。相比之下，小儿眶顶损伤患者中，性别分布近乎相等；此类典型患者为额底骨折，移位轻微或无移位（53% - 93%），伴有多系统损伤。小儿患者通常仅通过观察处理（53% - 86%）。对于成年患者，采用双侧颞部皮瓣或上睑成形术切口经颅下入路至眶顶，可提供广泛视野且并发症最少。目前可用的钛微螺钉、迷你螺钉及网片系统为眶顶重建提供了近乎理想的方式。并存的颅神经、额窦及眶上缘骨折的处理优先于眶顶骨折。与眶顶损伤相关的并发症可归类为以下原因导致的并发症：伴随损伤、手术入路、重建后体积差异、肌肉嵌顿、出血和/或感染。
