Clauser Luigi, Tieghi Riccardo
Unit of Craniomaxillofacial Surgery, Centre for Craniofacial Deformities and Orbital Surgery, Ferrara, Italy.
J Craniofac Surg. 2010 Jan;21(1):222-4. doi: 10.1097/SCS.0b013e3181c51123.
Endocrine orbitopathy is a systemic complex disease that involves the orbital contents. The symptoms are exophthalmos and correlated. The surgical techniques used to correct this condition can be fat decompression by the Olivari technique, 3-wall bony decompression, or the combination of these 2 surgical strategies, the ancillary procedure. Fat decompression is indicated when the intraconal and extraconal fat tissue is increased, whereas bony decompression is used in the presence of extraocular muscle involvement, associated with a normal quantity of intraconal-extraconal fat. Surgical techniques include the transconjunctival approach and ostectomy of the medial wall (when possible through endoscopy), orbital floor, and lateral wall of the orbit.Complications of this type of intervention are often represented by sensitivity disorders of the second branch of the trigeminal nerve, compressed by the intraorbital contents when they prolapse into the sinus. Possible sensitivity disorders are paresthesia, anesthesia, hypoaesthesia, dysesthesia, and hyperesthesia.The innovation introduced by the first author in 2007 consists of a mini ostectomy around the infraorbital foramen with removal of bone fragment. This determines relaxation of the nerve and makes easier the descent toward the sinus, allowing a larger expansion of the orbit contents. The absence of compression significantly reduces the sensitive complications. After treatment of the basic disease, surgical indications should be given according to the Werner classification. Fat decompression with the coronal approach is almost entirely abandoned for the transconjunctival approach, which allows adequate exposure of the lower orbit.The use of mini ostectomy of the infraorbital foramen combined with a 3-wall bony expansion showed a significant reduction of sensitive complications that often cause patient discomfort.
内分泌性眼眶病是一种累及眼眶内容物的全身性复杂疾病。症状为眼球突出及相关症状。用于矫正这种情况的手术技术可以是奥利瓦里技术的脂肪减压、三壁骨性减压或这两种手术策略（辅助手术）的组合。当眶内和眶外脂肪组织增加时，适合进行脂肪减压，而当存在眼外肌受累且眶内-眶外脂肪量正常时，则采用骨性减压。手术技术包括经结膜入路以及眼眶内侧壁（可能时通过内镜）、眶底和眶外侧壁的截骨术。这种干预的并发症通常表现为三叉神经第二支的感觉障碍，当眶内容物脱垂入鼻窦时，该神经会受到压迫。可能的感觉障碍有感觉异常、麻木、感觉减退、感觉迟钝和感觉过敏。第一作者在2007年引入的创新方法是在眶下孔周围进行微小截骨并去除骨碎片。这会使神经松弛，使向鼻窦的下移更容易，从而使眶内容物有更大的扩展空间。压迫的消除显著减少了感觉并发症。在治疗基础疾病后，应根据维尔纳分类给出手术指征。冠状入路的脂肪减压几乎已完全被经结膜入路所取代，后者能够充分暴露眼眶下部。眶下孔微小截骨术与三壁骨性扩展术联合使用，显著减少了常常导致患者不适的感觉并发症。
