Kim Dong Seok, Lee Jung Ho, Oh Deuk Young, Seo Je Won, Ahn Sang Tae, Rhie Jong Won
Department of Plastic Surgery, College of Medicine, Catholic University of Korea, Seoul, Korea.
J Craniofac Surg. 2010 May;21(3):932-4. doi: 10.1097/SCS.0b013e3181d7f0df.
Idiopathic orbital myositis (IOM) is a subtype of orbital inflammatory disease characterized by primarily involving the extraocular muscle. The signs and symptoms of IOM may also be seen in such processes as orbital cellulitis, primary or metastatic orbital neoplasm, carotid-cavernous fistulae, arteriovenous malformations, cavernous sinus thrombosis, and thyroid eye disease, and because there is no pathognomonic sign, symptoms, laboratory test, or radiologic findings, its diagnosis is often provisional. In our case, diagnosis of IOM was more difficult because our patient presented with proptosis after alloplastic implant insertion in the blow-out fracture. After considering radiologic and physical findings, we concluded that cellulitis was more likely as initial diagnosis. To remove foreign body or pus, surgical exploration was done, but intraoperative findings did not show any pus or sign of infection but diffuse enlargement and swelling of inferior rectus muscle. The diagnosis was confirmed as IOM, and the patient was treated with systemic corticosteroid. Although proptosis after alloplastic insertion in blow-out fracture is usually a sign of cellulitis, this case illustrates that it may also occur in patients with IOM.
特发性眼眶肌炎（IOM）是眼眶炎性疾病的一种亚型，其主要特征是累及眼外肌。眼眶蜂窝织炎、原发性或转移性眼眶肿瘤、颈动脉海绵窦瘘、动静脉畸形、海绵窦血栓形成以及甲状腺眼病等疾病过程中也可能出现IOM的体征和症状，而且由于缺乏特异性的体征、症状、实验室检查或影像学表现，其诊断往往是暂定的。在我们的病例中，IOM的诊断更为困难，因为我们的患者在爆裂性骨折植入异体材料后出现了眼球突出。综合考虑影像学和体格检查结果后，我们初步诊断更倾向于蜂窝织炎。为了清除异物或脓液，我们进行了手术探查，但术中未发现任何脓液或感染迹象，仅见下直肌弥漫性增大和肿胀。最终确诊为IOM，患者接受了全身糖皮质激素治疗。虽然爆裂性骨折植入异体材料后出现眼球突出通常是蜂窝织炎的表现，但该病例表明IOM患者也可能出现这种情况。
