Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
Clin Oral Investig. 2013 Apr;17(3):933-42. doi: 10.1007/s00784-012-0776-3. Epub 2012 Jul 1.
In the literature, there is an ongoing discussion about the influence of orbital fractures and the surgical approach on the rate of eyelid deformities of the lower eyelid.
We present an evaluation of a series of 221 patients 9 months after zygomaticomaxillary complex fracture repair that underwent implant removal. Reference anthropometric data were measured on standardized pre- and postoperative photographs. Analysis included eye fissure width and height, lid sulcus and upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion, and entropion. Both operated and contralateral eyelids were evaluated as well as whether a transconjunctival or a subciliary approach was performed.
Time, surgery, and surgical approach presented significant effects on eye fissure index and lower iris coverage. Scleral show was significantly influenced by the surgical procedure itself as well as by the type of incision. The rate of ectropion increased significantly pre- to postoperative.
The subciliary approach included the highest risk of lower lid retraction. The low pre- to postoperative increase of scleral show and ectropion compared to recent studies gives us an idea about the influence of the underlying trauma on the rate of lower lid retraction. The standardized measurements described are accurately and objective to evaluate postoperative results.
The transconjunctival approach is preferable in orbital fracture repair.
文献中一直在讨论眼眶骨折和手术入路对下眼睑眼睑畸形发生率的影响。
我们评估了 221 例接受颧骨复合体骨折修复后 9 个月行植入物取出的患者。在标准化的术前和术后照片上测量参考人体测量数据。分析包括眼裂宽度和高度、睑槽和上睑高度、上、下虹膜覆盖、角膜至下睑缘的位置、内眦倾斜、巩膜显露、下睑外翻和下睑内翻。对手术侧和对侧眼睑进行评估，并评估是否采用经结膜或经皮入路。
时间、手术和手术入路对眼裂指数和下虹膜覆盖有显著影响。巩膜显露除受手术本身影响外，还受切口类型影响。术前至术后下睑外翻的发生率显著增加。
经皮入路的下睑退缩风险最高。与最近的研究相比，巩膜显露和下睑外翻的术前至术后低增加表明了基础创伤对下睑退缩发生率的影响。描述的标准化测量方法准确、客观，可用于评估术后结果。
在眼眶骨折修复中，经结膜入路更可取。
