Kim Kwang Seog, Kim Eui Sik, Hwang Jae Ha
Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
Plast Reconstr Surg. 2006 May;117(6):1947-55. doi: 10.1097/01.prs.0000218330.55731.2d.
The transcutaneous transorbital approach to medial orbital wall fractures facilitates placing a large implant or autogenous graft. However, its major disadvantage is the difficulty of accurately reducing the fractured medial orbital wall and herniated soft tissues with minimal morbidity.
To resolve this problem, a combined transcutaneous transethmoidal/transorbital approach through the same skin incision was developed at the Chonnam National University Medical School. Between 1997 and 2003, this approach was used in 54 patients with pure medial orbital blowout fractures. All fractures were larger than 2 cm in defect size and had 3 mm or more of bone displacement.
Postoperative computed tomographic scans showed complete release of entrapped soft tissues and accurate reconstruction of bone defects in all cases. Complications related to the operation such as intraorbital and intramuscular hemorrhage, infection, and eyeball and optic nerve injuries were not observed, except in two cases with slight implant displacement. Follow-up ranged from 2 to 22 months, with an average of 9 months. Forty-one patients were evaluated 6 months or more after their reconstructive procedure. At the time of surgery, diplopia was present in 39 patients, eyeball movement limitation in 35 orbits, and enophthalmos of more than 2 mm in 16 orbits. Postoperatively, diplopia and eyeball movement limitation were resolved in most cases. Two patients had persistent diplopia for more than 1 year after surgery, and one of these needed extraocular muscle surgery. Enophthalmos of more than 2 mm developed in three orbits, but enophthalmos of more than 3 mm was not observed in any orbit. Cosmetic results at the incision site were acceptable in all patients.
The combined transcutaneous transethmoidal/transorbital approach is a safe procedure that can be performed with minimal morbidity; it offers the advantages of both the transcutaneous approach and the trans-nasal approach. Therefore, the authors suggest that this method be considered as a surgical alternative for the treatment of medial orbital blowout fractures, especially large and combined fractures of the medial wall and other parts of the orbit.
经皮经眶入路治疗眶内侧壁骨折便于植入大型植入物或自体移植物。然而，其主要缺点是难以在发病率最低的情况下准确复位骨折的眶内侧壁和疝出的软组织。
为解决这一问题，全南国立大学医学院开发了一种通过相同皮肤切口的经皮经筛窦/经眶联合入路。1997年至2003年期间，该入路用于54例单纯眶内侧壁爆裂性骨折患者。所有骨折缺损尺寸均大于2 cm，骨移位3 mm或更多。
术后计算机断层扫描显示所有病例中嵌顿的软组织均完全松解，骨缺损得到准确重建。除两例植入物略有移位外，未观察到与手术相关的并发症，如眶内和肌内出血、感染以及眼球和视神经损伤。随访时间为2至22个月，平均9个月。41例患者在重建手术后6个月或更长时间接受了评估。手术时，39例患者存在复视，35个眼眶存在眼球运动受限，16个眼眶存在超过2 mm的眼球内陷。术后，大多数病例的复视和眼球运动受限得到解决。两名患者术后持续性复视超过1年，其中一名需要进行眼外肌手术。三个眼眶出现超过2 mm的眼球内陷，但任何眼眶均未出现超过3 mm的眼球内陷。所有患者切口部位的美容效果均可接受。
经皮经筛窦/经眶联合入路是一种安全的手术方法，发病率极低；它兼具经皮入路和经鼻入路的优点。因此，作者建议将该方法视为治疗眶内侧壁爆裂性骨折，尤其是内侧壁与眼眶其他部位的大型联合骨折的手术替代方法。
