Gauthier J, Conessa C, Pons Y, Meningaud J-P
Hôpital d'Instruction des Armées du Val de Grâce, Service ORL et Chirurgie Cervico-Faciale, 75005 Paris, France.
Rev Laryngol Otol Rhinol (Bord). 2009;130(3):159-62.
Medial wall orbital fractures can result from external trauma (midfacial trauma, blow out) or from endonasal trauma (functional endoscopic sinus surgery). Entrapment of the medial rectus muscle can lead to optical complications if not treated (restriction of ocular mobility, diplopia). Enophtalmos can also be the result of extrusion of orbital fat into the ethmoïdal cavities. Surgical repair entails treatment and prevention of these complications.
Define the contribution of endoscopy and retrocaruncular incision, particularly in terms of accessibility and visibility of the posterior third of the medial wall of the orbit.
Six patients with medial orbital wall fractures were treated between May 2006 and May 2007 using a retrocaruncular approach assisted peroperatively by endoscopy. No complications occurred during the postoperative follow up. The authors describe the surgical techniques used.
Retrocaruncular approach is a safe and effective technique that presents the particular advantage of not leaving a dysesthetic scar. Peroperative endoscopy allows then a better accessibility and visibility of the posterior third of the medial orbital wall.
眶内侧壁骨折可由外部创伤(面中部创伤、爆裂伤)或鼻内创伤(功能性鼻内镜鼻窦手术)引起。如果不进行治疗,内侧直肌嵌顿可导致视力并发症(眼球活动受限、复视)。眼球内陷也可能是眶脂肪挤入筛窦腔的结果。手术修复需要治疗和预防这些并发症。
明确内镜检查和泪阜后切口的作用,特别是在眶内侧壁后三分之一的可达性和可视性方面。
2006年5月至2007年5月期间,对6例眶内侧壁骨折患者采用泪阜后入路,并在手术中辅以内镜检查。术后随访期间未发生并发症。作者描述了所使用的手术技术。
泪阜后入路是一种安全有效的技术,其特别优点是不会留下感觉异常的瘢痕。术中内镜检查可使眶内侧壁后三分之一的可达性和可视性更好。