Tahernia Amir, Erdmann Detlev, Follmar Keith, Mukundan Srinivasan, Grimes Jason, Marcus Jeffrey R
Durham, N.C. From the Interdisciplinary Craniofacial Imaging Laboratory and the Department of Biomedical Engineering, Duke University, and the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery and the Department of Radiology, Duke University Medical Center.
Plast Reconstr Surg. 2009 Mar;123(3):968-975. doi: 10.1097/PRS.0b013e318199f486.
Orbital floor injuries can occur in isolation or in association with zygomaticomaxillary complex fractures. Volumetric computed tomographic measurements of affected orbits are investigated for utility in guiding management in these two groups.
The medical records of all patients with craniomaxillofacial injuries (2003 to 2005) were reviewed. Of 522 total patients, 45 patients had isolated orbital floor fractures, 13 of whom underwent repair (29 percent), and 64 had zygomaticomaxillary complex fractures, 36 of whom underwent reconstruction (56 percent) and 10 of whom underwent orbital floor repair (16 percent). Radiographic criteria for floor exploration included 50 percent area fracture in isolated injuries and 10-mm estimated zygomaticomaxillary complex compression in zygomaticomaxillary complex-associated floor injuries. Volume measurements of the affected orbits were obtained and compared with the uninjured contralateral orbit.
Before treatment in the operative zygomaticomaxillary complex group, there was an average decrease in orbital volume of 18.3 percent. In the isolated orbital floor group, there was an average increase in orbital volume of 28.3 percent.
Zygomaticomaxillary complex-associated orbital floor injuries can be compressive injuries associated with loss of volume, whereas isolated injuries generally result in volume expansion. Radiographic criteria are often considered in the decision to proceed with orbital floor exploration to avoid late enophthalmos. The literature suggests that a 20 percent change in orbital volume results in perceptible deformity. Therefore, a radiographic criterion of 50 percent floor area (28 percent volume increase) in isolated injuries may be too stringent; an estimated 10 mm of compression (18.3 percent volume change) is a reasonable operative criterion for floor exploration in zygomaticomaxillary complex-associated injuries.
眶底损伤可单独发生，也可与颧骨上颌复合体骨折同时出现。本研究旨在探讨通过对患侧眼眶进行容积计算机断层扫描测量，以指导这两组损伤的治疗。
回顾了所有颅颌面损伤患者（2003年至2005年）的病历。在总共522例患者中，45例为单纯眶底骨折，其中13例接受了修复（29%）；64例为颧骨上颌复合体骨折，其中36例接受了重建（56%），10例接受了眶底修复（16%）。眶底探查的影像学标准包括单纯损伤时骨折面积达50%，以及颧骨上颌复合体相关眶底损伤时颧骨上颌复合体估计压缩10毫米。获取患侧眼眶的容积测量值，并与未受伤的对侧眼眶进行比较。
在接受手术的颧骨上颌复合体骨折组中，治疗前眼眶容积平均减少18.3%。在单纯眶底骨折组中，眼眶容积平均增加28.3%。
颧骨上颌复合体相关眶底损伤可能是伴有容积丢失的压缩性损伤，而单纯损伤通常导致容积增大。在决定是否进行眶底探查以避免晚期眼球内陷时，通常会考虑影像学标准。文献表明，眼眶容积变化20%会导致明显畸形。因此，单纯损伤时50%的骨折面积（容积增加28%）这一影像学标准可能过于严格；估计10毫米的压缩（容积变化18.3%）是颧骨上颌复合体相关损伤时眶底探查的合理手术标准。
