Fernandes Rui, Fattahi Tirbod, Steinberg Barry, Schare Howard
Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
J Oral Maxillofac Surg. 2007 Aug;65(8):1449-53. doi: 10.1016/j.joms.2006.10.080.
This study was designed to assess the use of the endoscopic transmaxillary approach to correcting orbital blowout fractures (OBFs) with placement of alloplastic implants.
This was a prospective study of patients treated in the Division of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville over a 6-month period, July to December 2005. Ten patients (7 males, 3 females, age range 19 to 47 years [average age 37.3 years]) met the inclusion criteria for the study and consented to undergo surgical repair. The injury was most commonly secondary to assault (6 cases); the remainder were secondary to motor vehicle collisions. The time from injury to correction ranged from 3 to 36 days (average, 10.9 days). A computed tomography scan with axial and coronal views was obtained in each patient at the time of presentation. All patients who met the inclusion criteria for the study underwent an endoscopic-assisted transmaxillary repair of their OBF with placement of a Medpor implant (Porex Surgical Products, Newnan, GA).
Of the 10 patients, 9 presented with diplopia preoperatively and 4 had associated entrapment on upward gaze. One patient did not have entrapment or diplopia but had a fracture larger than 2 cm(2). All patients underwent successful OBF repair with placement of a Medpore implant through the endoscopic transmaxillary approach, and all experienced resolution of preoperative diplopia and/or entrapment. None of the patients developed enophthalmos at a mean follow-up of 12.7 weeks.
The endoscopic transmaxillary approach to correcting OBF is an excellent alternative to the transconjunctival approach. This approach carries a very low morbidity and may be used in circumstances in which conventional approaches are not feasible.
本研究旨在评估采用内镜经上颌窦入路并植入异体植入物矫正眼眶爆裂性骨折（OBF）的应用情况。
这是一项对2005年7月至12月在佛罗里达大学医学院杰克逊维尔分校口腔颌面外科接受治疗的患者进行的前瞻性研究。10例患者（7例男性，3例女性，年龄范围19至47岁[平均年龄37.3岁]）符合研究纳入标准并同意接受手术修复。损伤最常见于袭击（6例）；其余为机动车碰撞所致。从受伤到矫正的时间为3至36天（平均10.9天）。每位患者就诊时均进行了轴位和冠状位计算机断层扫描。所有符合研究纳入标准的患者均接受了内镜辅助经上颌窦修复其眼眶爆裂性骨折，并植入了Medpor植入物（Porex Surgical Products，Newnan，佐治亚州）。
10例患者中，9例术前出现复视，4例向上凝视时有相关的眼球陷顿。1例患者没有眼球陷顿或复视，但骨折大于2 cm²。所有患者均通过内镜经上颌窦入路成功植入Medpore植入物修复眼眶爆裂性骨折，且所有患者术前复视和/或眼球陷顿均得到缓解。平均随访12.7周时，无患者出现眼球内陷。
内镜经上颌窦入路矫正眼眶爆裂性骨折是结膜下入路的极佳替代方法。该方法发病率极低，可用于传统方法不可行的情况。
