Bellini Chiara M, Raimondi Manuela T, Grecchi Francesco
II Maxillo-Facial Surgical Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
J Craniomaxillofac Surg. 2007 Jun-Jul;35(4-5):234-40. doi: 10.1016/j.jcms.2007.03.003. Epub 2007 Sep 14.
Correction of micro-orbitism, resulting from clinical or congenital anophthalmia, has traditionally been performed by multiple segmentation of the orbital rim, orbital expanders and orbital conformers. Although distraction osteogenesis is a widely employed surgical approach in the treatment of patients with bony malformations, it has not been employed to enlarge micro-orbits.
The present article describes the development of a new bi-directional orbital distractor to treat a 17-year-old patient affected by micro-orbitism, caused by clinical anophthalmia. The deformity required an internal device to expand and to pull the orbit laterally. Surgical planning and device design were performed by means of patient-specific finite element analysis and a stereolithography model. The surgery consisted of a uni-lateral orbito-malar osteotomy performed via coronal and intraoral access. A 7-day-latency period was observed. The consolidation phase was chosen as six months.
At the end of the distraction process, symmetry of the malar bones and orbital roofs was achieved. During removal of the device, newly formed bone was found at the original osteotomy and distraction gaps.
The reported clinical case suggests that distraction osteogenesis can be a useful procedure for enlargement of micro-orbits. Despite this, a number of questions need to be addressed by long-term follow-up and careful study of future cases.
传统上，因临床或先天性无眼球症导致的小眼眶矫正，是通过对眶缘进行多次分割、使用眼眶扩张器和眼眶塑形器来完成的。尽管牵张成骨术是治疗骨畸形患者广泛采用的手术方法，但尚未用于扩大小眼眶。
本文描述了一种新型双向眼眶牵张器的研发，用于治疗一名因临床无眼球症导致小眼眶的17岁患者。该畸形需要一种内部装置来扩张并向外侧牵拉眼眶。通过患者特异性有限元分析和立体光刻模型进行手术规划和装置设计。手术包括经冠状切口和口内入路进行单侧眶颧截骨术。观察到7天的延迟期。巩固期选择为6个月。
在牵张过程结束时，颧骨和眶顶实现了对称。在取出装置时，在原截骨处和牵张间隙发现了新形成的骨。
报告的临床病例表明，牵张成骨术可能是扩大小眼眶的一种有效方法。尽管如此，仍有一些问题需要通过长期随访和对未来病例的仔细研究来解决。
