Jamal Basem T, Pfahler Scott M, Lane Kate A, Bilyk Jurj R, Pribitkin Edmund A, Diecidue Robert J, Taub Daniel I
Oral and Maxillofacial Surgery Department, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Oral Maxillofac Surg. 2009 May;67(5):986-9. doi: 10.1016/j.joms.2008.12.035.
Injuries to the middle third of the face commonly destroy the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7% and 90.6% in reported series. This article is a retrospecitve, descriptive case study assessing the spectrum and incidence of ophthalmic involvement in patients presenting with zygomaticomaxillary complex (ZMC) fractures.
Ninety-six patients with ZMC fractures who were surgically treated in 1 academic institution between 1996 and 2006 were assessed pre- and postoperatively by the same oculoplastic surgeon and were included in the study. All patients had a thorough ophthalmologic examination that included assessment of visual acuity, pupillary reactivity, anterior and posterior segment examination, and extraocular motility. In cases of optic neuropathy, automated perimetry was also performed. The variables reviewed included patients' age, gender, mechanism of injury, visual acuity, pupillary reactivity, extraocular motility, presence or absence of diplopia, ocular and orbital findings, and intraorbital hypoesthesia.
Gender distribution of the patients was 88% male, with a mean age of 36 years. The most common etiology of trauma was assult (56%), followed by falls (21%). Most patients (66.6%) sustained minor ocular injuries such as subconjuctival hemorrhage, iris sphincter tear, and corneal abrasion. Subconjunctival hemorrhage was the most common minor injury, accounting for 55% of the cases. Major injuries such as ruptured globe and retinal hemorrhage occurred in 10% of the patients. Orbital findings such as restriction of extraocular movement occurred in 15% of cases. Symptomatic diplopia was noted in 16% of the patients and traumatic optic neuropathy occurred in 6%. Diplopia significantly improved in the first 3 postoperative months, dropping from a preoperative incidence of 16% to 2%.
Comminuted ZMC fractures had been reported to be associated with a signficantly higher incidence of visual sequelae than other forms of midfacial injury. A 10% incidence of major or blinding injuries and a 6% incidence of traumatic optic neuropathy are significant, and warrants a prompt ophthalmologic examination of all patients with ZMC fractures as quickly as possible, and always preoperatively in injuries necessitating surgical repair.
面部中三分之一区域的损伤通常会破坏眼眶骨骼的完整性，并且常伴有眼部损伤，在已报道的病例系列中，眼部损伤发生率在2.7%至90.6%之间。本文是一项回顾性描述性病例研究，评估颧上颌复合体（ZMC）骨折患者眼部受累的范围和发生率。
对1996年至2006年间在1家学术机构接受手术治疗的96例ZMC骨折患者，由同一位眼整形医生在术前和术后进行评估，并纳入本研究。所有患者均接受了全面的眼科检查，包括视力评估、瞳孔反应、眼前段和后段检查以及眼外肌运动检查。对于视神经病变的病例，还进行了自动视野检查。所回顾的变量包括患者的年龄、性别、损伤机制、视力、瞳孔反应、眼外肌运动、有无复视、眼部和眼眶检查结果以及眶内感觉减退。
患者的性别分布为男性占88%，平均年龄为36岁。最常见的创伤病因是袭击（56%），其次是跌倒（21%）。大多数患者（66.6%）遭受轻微眼部损伤，如结膜下出血、虹膜括约肌撕裂和角膜擦伤。结膜下出血是最常见的轻微损伤，占病例的55%。10%的患者发生了严重损伤，如眼球破裂和视网膜出血。15%的病例出现眼眶检查结果，如眼外肌运动受限。16%的患者出现有症状的复视，6%的患者发生创伤性视神经病变。复视在术后前3个月显著改善，术前发生率从16%降至2%。
据报道，粉碎性ZMC骨折与其他形式的面中部损伤相比，视觉后遗症的发生率显著更高。10%的严重或致盲性损伤发生率以及6%的创伤性视神经病变发生率不容忽视，这就需要对所有ZMC骨折患者尽快进行及时的眼科检查，对于需要手术修复的损伤，应始终在术前进行检查。
