Division of Trauma Plastic Surgery,Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Plast Reconstr Surg. 2010 Mar;125(3):969-78. doi: 10.1097/PRS.0b013e3181cb64b2.
Transantral endoscopic repair of orbital floor fracture minimizes the risk of implant misplacement and avoids complications associated with traditional lower eyelid approaches. Contrary to most publications, its application is not limited to early intervention of pure orbital blow-out fractures. The authors present their results of broad application of this technique, with longer-term patients' follow-up.
A retrospective review of 32 patients over a 10-year period (March of 1998 to June of 2008) was performed. The mean duration of follow-up was 27.5 months (range, 4 months to 10 years). Sixteen patients (50 percent) had associated zygoma, inferior orbital rim, and Le Fort I fractures. Twenty-five patients (78.1 percent) had enophthalmos, with 14 of these cases being 2 mm or more in severity. Diplopia was present in 15 patients (46.9 percent) preoperatively. Operations were performed within 2 weeks for 25 patients (78.1 percent). Twenty-eight patients required orbital floor reconstructions. Four of five patients with associated orbital medial wall fractures underwent simultaneous orbital medial wall reconstruction.
All patients had successful reduction of orbital fractures. Two patients had residual enophthalmos of 1 mm postoperatively. Due to delay in surgery and the nature of injury, only 11 of the 15 patients with diplopia had complete resolution after surgery. One patient required drainage of recurrent sinusitis 1 year after surgery.
In suitably selected patients with orbital floor fractures, the transantral endoscopic approach is safe and reliable. Delayed surgery or associated zygomaticomaxillary complex fractures are not contraindications for the use of this technique. Long-term follow-up showed maintenance of the surgical results.
经鼻内镜眶底骨折修复术可最大程度降低植入物错位风险，并避免传统下眼睑入路相关并发症。与大多数文献不同，该技术的应用不仅限于单纯眶爆裂性骨折的早期干预。作者报告了他们广泛应用该技术的结果，并对患者进行了更长期的随访。
对 10 年间（1998 年 3 月至 2008 年 6 月）的 32 例患者进行回顾性分析。平均随访时间为 27.5 个月（4 个月至 10 年）。16 例患者（50%）合并颧骨、眶下缘和 Le Fort I 骨折。25 例患者（78.1%）存在眼球内陷，其中 14 例程度为 2 毫米或以上。术前存在复视的患者有 15 例（46.9%）。25 例患者（78.1%）在 2 周内进行了手术。28 例患者需要进行眶底重建。5 例合并眶内侧壁骨折的患者中，有 4 例同时进行了眶内侧壁重建。
所有患者的眶骨骨折均得到成功复位。术后 2 例患者存在 1 毫米的残余眼球内陷。由于手术延迟和损伤性质，15 例复视患者中仅有 11 例术后完全缓解。1 例患者术后 1 年因鼻窦复发需要引流。
在选择合适的眶底骨折患者中，经鼻内镜入路是安全可靠的。延迟手术或合并颧骨-上颌骨复合体骨折并非该技术的禁忌证。长期随访显示手术效果得以维持。
