Kosaka Masaaki, Mizoguchi Takayuki, Matsunaga Kazuhide, Fu Rong, Nakao Yuzo
Department of Plastic and Reconstructive Surgery, Kinki University School of Medicine, Osaka, Japan.
J Craniofac Surg. 2006 Nov;17(6):1251-8. doi: 10.1097/01.scs.0000248646.92415.eb.
Surgical intervention consisting of lateral orbitotomy, the indication of which is extremely wide for orbital tumor surgery, has been applied in cases of large, retrobulbar cavernous hemangioma. However, no method exists involving displacement of the tumor from the crowded orbital contents, with the exception of tumor traction toward the outer side. The impact of traction force on the fragile hemangioma is extremely traumatic and dangerous. The authors examined how a tumor might be "displaced" in the absence of traction force effect, into an appropriate cavity neighboring the orbit. The maxillary sinus may afford the most suitable space to shift the laterally situated orbital tumor. Thus, the osteotomy level was extended to the lateral half of the inferior orbital floor and orbital rim in order to displace the tumor through an "escape window" of sufficient size between the orbit and maxilla. This report describes the treatment of two cases with long histories of progressive proptosis associated with retrobulbar large cavernous hemangiomas. This novel procedure resulted in a successful outcome. The current approach and management, which involves displacement of the tumor into the maxillary sinus through the orbital floor escape window, is a novel procedure for orbital tumor surgery.
手术干预包括外侧眶切开术，其在眼眶肿瘤手术中的适应证极为广泛，已应用于大型球后海绵状血管瘤病例。然而，除了将肿瘤向外牵拉外，尚无方法能够使肿瘤从拥挤的眼眶内容物中移位。牵拉力对脆弱的血管瘤的影响极具创伤性且危险。作者研究了在无牵拉力作用的情况下，如何将肿瘤“移位”至眼眶邻近的合适腔隙。上颌窦可能为移位位于外侧的眼眶肿瘤提供最合适的空间。因此，截骨水平扩展至眶下壁和眶缘的外侧半，以便通过眼眶与上颌骨之间足够大的“逃逸窗口”使肿瘤移位。本报告描述了两例伴有球后大型海绵状血管瘤且有长期进行性眼球突出病史的病例的治疗情况。这一新颖的手术取得了成功的结果。目前这种通过眶底逃逸窗口将肿瘤移位至上颌窦的手术方法和治疗方式，是眼眶肿瘤手术的一种新颖术式。
