Oreroglu Ali Rıza, Silav Gokalp, Ozkaya Ozay, Orman Cagdas, Akan Mithat
Istanbul Okmeydanı Research and Training Hospital, Plastic, Reconstructive and Esthetic Surgery Clinic, Istanbul, Turkey.
Turk Neurosurg. 2013;23(3):395-400. doi: 10.5137/1019-5149.JTN.5444-11.2.
Early closure of cranial sutures results in various types of cranial vault deformities, named craniosynostosis. Although mostly associated with syndromic cases, bony orbit deformities such as exorbitism can be seen with various types of craniosynostosis. This condition can be associated with papilledema and besides its effect on the patient's appearance can cause subluxation of the globe, lagophthalmos or keratitis resulting in corneal ulcers and ultimately loss of vision. Various techniques have been proposed for repair or exorbitism such as fronto-orbital advancement procedures, orbital wall decompression, periosteum scoring and tissue excision. Orbital periosteal scoring covering the globe can be extremely efficient for orbital fat decompression when combined with other orbital volume expanding procedures. We hereby present two late cases of craniosynostosis associated with bilateral exorbitism due to orbital shallowness for which cranial vault reconstruction was performed simultaneously with combinations of fronto-orbital advancement, orbital decompression and periosteal scoring. The late referral of these patients at ages older than the usual time of operation indication made the surgical procedure for craniosynostosis repair and exorbitism treatment challenging. The combined and simultaneous use of bone advancement, orbital wall decompression and specially periosteum scoring can be highly efficient in the treatment of exorbitism associated with craniosynostosis.
颅骨缝过早闭合会导致各种类型的颅穹窿畸形，即颅缝早闭。尽管大多与综合征病例相关，但在各种类型的颅缝早闭中都可见到如眼球突出等眼眶骨畸形。这种情况可能与视乳头水肿有关，除了影响患者外观外，还会导致眼球半脱位、兔眼或角膜炎，进而引起角膜溃疡，最终导致视力丧失。已经提出了各种修复眼球突出的技术，如额眶前移手术、眶壁减压、骨膜划痕和组织切除。当与其他扩大眼眶容积的手术相结合时，覆盖眼球的眼眶骨膜划痕对眼眶脂肪减压可能非常有效。我们在此介绍两例因眼眶浅而导致双侧眼球突出的颅缝早闭晚期病例，针对这两例患者，在进行颅穹窿重建的同时，联合应用了额眶前移、眼眶减压和骨膜划痕术。这些患者在超过通常手术指征年龄时才转诊，这使得颅缝早闭修复和眼球突出治疗的手术过程具有挑战性。联合并同时使用骨前移、眶壁减压，特别是骨膜划痕术，在治疗与颅缝早闭相关的眼球突出方面可能非常有效。
