Nemoto Hitoshi, Ito Yoshinori, Kasai Yoshiaki, Maruyama Naoki, Kimura Naohiro, Sumiya Noriyoshi
From the Department of Plastic and Reconstructive Surgery, Fujigaoka Hospital, Showa University School of Medicine, Yokohama, Kanagawa, Japan.
Ann Plast Surg. 2015 Feb;74(2):195-8. doi: 10.1097/SAP.0b013e3182956596.
The orbital floor is one of the most frequently broken bones in maxillofacial fracture, and orbital reconstruction is needed in many cases. Various materials are used for orbital floor reconstruction. We report here orbital reconstruction using autologous orbital bone with cyanoacrylate. Entrapped soft tissues were freed and repositioned intraorbitally and bone fragments were gathered with a microscope simultaneously. The bone fragments were fixed to a board of bone with ethyl-2-cyanoacrylate and returned to the orbital fracture site. Of 96 fresh orbital floor fractures, this method was used for 31 (32.3%) patients. Simple reduction was performed in 48 patients. Bone graft with iliac crest was performed in the other 12 patients. Reconstruction with alloplastic materials was performed in 5 patients. Diplopia was corrected in 26 patients on whom this method was performed. The reconstructed bone collapsed into the maxillary sinus in 1 patient who underwent iliac bone graft on reoperation. Another 4 patients did not show diplopia preoperatively. None of the patients showed enophthalmos, foreign body reaction, or infection postoperatively. We were able to perform orbital bone reconstruction with autologous orbital bone without another donor site in 30 (62.5%) of 48 cases that required grafting. The indications for this method are that a sufficient quantity of bone fragments can be obtained and returned on a board of bone which can be stabilized in the orbit without collapsing into the maxillary sinus. Good results were obtained, and we consider this to be a safe and useful method.
眶底是颌面骨折中最常发生骨折的部位之一，许多病例都需要进行眼眶重建。多种材料被用于眶底重建。我们在此报告使用自体眶骨联合氰基丙烯酸酯进行眼眶重建的情况。将嵌顿的软组织松解并重新放置于眶内，同时在显微镜下收集骨碎片。用2-氰基丙烯酸乙酯将骨碎片固定在一块骨板上，然后放回眼眶骨折部位。在96例新鲜眶底骨折患者中，31例（32.3%）采用了该方法。48例患者进行了单纯复位。另外12例患者采用了髂嵴骨移植。5例患者采用了异体材料重建。在采用该方法的26例患者中，复视得到了纠正。1例接受髂骨移植的患者再次手术时，重建骨塌陷进入上颌窦。另外4例患者术前无双视。所有患者术后均未出现眼球内陷、异物反应或感染。在48例需要植骨的病例中，30例（62.5%）我们能够使用自体眶骨进行眼眶骨重建，而无需另取供区。该方法的适应证是能够获得足够数量的骨碎片，并将其固定在一块骨板上，该骨板能够在眼眶内稳定，而不会塌陷进入上颌窦。取得了良好的效果，我们认为这是一种安全有效的方法。
