Brucoli Matteo, Arcuri Francesco, Giarda Mariangela, Benech Rodolfo, Benech Arnaldo
Department of Maxillo-Facial Surgery, Azienda Ospedaliera Maggiore della Carità, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy.
J Craniofac Surg. 2012 Jan;23(1):e58-61. doi: 10.1097/SCS.0b013e3182418cc9.
Retrobulbar hematoma is a rare condition but represents a diagnostic and therapeutic emergency. It occurs in between 0.3% and 3.5% of facial traumas and can be caused by direct or indirect injury of the orbit; they can be classified into intraorbital and subperiosteal hematoma. We describe 4 different cases of posttraumatic retrobulbar hematoma treated at the Unit of Maxillofacial Surgery of the Novara Major Hospital between January 2005 and December 2009, each different from the others for morphologic aspects, and we discuss its diagnosis and management. Surgery decompression of the orbit is recommended when visual deficit arises and when there is no response to pharmacologic therapy. Several techniques for orbital decompression have been proposed. The lateral canthotomy and/or the inferior cantholysis are the 2 techniques most practiced. Anterior-chamber paracentesis is effective, but it is rarely indicated for frequent complications such as cataract formation, herniation of the iris, infection, and trauma to the canal of Schlemm. Other procedures including transantral ethmoidectomy, transantral sphenoidectomy, and transfrontal craniotomy are described.
球后血肿是一种罕见的病症，但却是诊断和治疗上的急症。它在面部创伤中发生率为0.3%至3.5%，可由眼眶的直接或间接损伤引起；可分为眶内血肿和骨膜下血肿。我们描述了2005年1月至2009年12月期间在诺瓦拉市大医院颌面外科治疗的4例不同的创伤后球后血肿病例，每例在形态学方面都互不相同，并讨论了其诊断和处理方法。当出现视力缺损且药物治疗无反应时，建议进行眼眶手术减压。已经提出了几种眼眶减压技术。外眦切开术和/或下睑眦部松解术是最常用的两种技术。前房穿刺有效，但由于其频繁出现如白内障形成、虹膜疝、感染和施莱姆管损伤等并发症，很少被采用。还描述了其他手术，包括经鼻窦筛窦切除术、经鼻窦蝶窦切除术和经额开颅术。
