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内镜下修复孤立性额窦前壁骨折且无需固定

Endoscopic repair of isolated anterior table frontal sinus fractures without fixation.

作者信息

Egemen Onur, Özkaya Özay, Aksan Tolga, Bingöl Derya, Akan Mithat

机构信息

Okmeydanı Training and Research Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Istanbul, Turkey.

出版信息

J Craniofac Surg. 2013 Jul;24(4):1357-60. doi: 10.1097/SCS.0b013e3182902518.

Abstract

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

摘要

额窦骨折占颌面骨折的5%至15%,孤立的前壁损伤占额窦骨折的33%。额窦骨折的治疗策略应根据损伤程度个体化。对于轻度和中度移位(1 - 5毫米)的闭合性孤立前壁额窦骨折,采用内镜辅助修复且不使用任何固定方法是一种很好的替代治疗技术。2010年4月至2011年12月,对5例轻度和中度移位的孤立前壁骨折患者进行了治疗。患者前额皮肤无裂伤。术前,患者骨折部位出现前额凹陷,并进行了计算机断层扫描以确定额窦骨折的程度。所有患者均采用内镜辅助闭合复位治疗。所有骨折均成功复位。无一例患者需要转为传统切口技术。无患者需要固定材料。所有患者的美容畸形均得到完美矫正。在额窦骨折的标准治疗方式中,最好采用冠状切口进行修复。然而,双冠状切口有许多缺点。最近有几位作者描述了一些针对这些损伤的内镜和闭合方法。这些方法的主要缺点是视野不佳或需要使用外源性材料进行固定。对于轻度和中度移位的闭合性孤立前壁额窦骨折,不进行固定的内镜下复位是可行的。在特定病例中可取得良好的临床效果。

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