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颧骨复合体骨折伴异物存留后的眼部重建。

Ocular reconstruction after zygomatic complex fracture with retention of a foreign body.

作者信息

Faverani Leonardo Perez, Capelari Marcos Maurício, Ramalho-Ferreira Gabriel, Gomes-Filho José Carlos Oliveira, Fabris André Luís da Silva, Marzola Clóvis, Toledo Gustavo Lopes, Toledo-Filho João Lopes

机构信息

Oral and Maxillofacial Surgery with the Bauru Hospital Association and UNESP, Araçatuba Dental School, São Paulo, Brazil.

出版信息

J Craniofac Surg. 2011 Jul;22(4):1394-7. doi: 10.1097/SCS.0b013e31821cc2e2.

Abstract

Facial injuries with the retention of foreign bodies inside the tissues, both in soft and hard ones, can cause major functional and aesthetic damage. Among the different etiological agents, cutting tools, fragments of a firearm, the splinter of wood, steel, or iron, launched by misuse, or even caused by defects in equipment, are the main cause of these injuries. The aim of this study was to discuss the peculiarity of the multidisciplinary approach in caring of a 33-year-old man, victim of an accident at work, by the rupture of an emery disc and consequent penetration of the fragments in violation of the tissues in the orbital and zygomatic region of the left side, with perforation of the eyeball and orbital-zygomatic fracture. Urgent treatment consisted of debridement of wounds, bleeding control, removal of foreign bodies, fracture reduction with rigid internal fixation, and suture, performed by the oral and maxillofacial surgical team. Reconstruction of orbital tissues by the ophthalmology team consisted of suture of the injuries. About 1 month after the trauma, phthisis bulbi was noted, and the patient underwent a new procedure under general anesthesia for eye evisceration and installation of an alloplastic prosthesis associated with the homogenous sclera. Facial harmony was restored, especially in aesthetics and function of the zygomatic-orbital complex.

摘要

面部组织内留有异物的损伤,无论是软组织还是硬组织损伤,均可导致严重的功能和美观损害。在不同的病因中,切割工具、火器碎片、因误用发射的木片、钢片或铁片,甚至因设备缺陷造成的碎片,是这些损伤的主要原因。本研究的目的是探讨多学科方法在护理一名33岁男性患者中的特殊性,该患者是一名工伤事故受害者,因砂轮破裂,碎片穿透左侧眼眶和颧骨区域的组织,导致眼球穿孔和眶颧骨折。紧急治疗包括伤口清创、止血、取出异物、采用坚固内固定进行骨折复位和缝合,由口腔颌面外科团队实施。眼科团队对眼眶组织的重建包括对损伤进行缝合。外伤后约1个月,出现眼球痨,患者在全身麻醉下接受了新的手术,进行眼球摘除并安装与同种异体巩膜相关的异体植入假体。面部协调性得以恢复,尤其是在颧眶复合体的美观和功能方面。

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