Kempton Steve J, Cho David C, Thimmappa Brinda, Martin Mark C
From the *Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospital and Clinics, Madison, WI; †Straub Clinic and Hospital, Plastic Surgery Practice, Honolulu, HI; ‡Department of Plastic Surgery, Wake Forest Medical Center, Winston-Salem, NC; and §Department of Plastic and Reconstructive Surgery, Loma Linda University, Loma Linda, CA.
Ann Plast Surg. 2016 Mar;76(3):295-300. doi: 10.1097/SAP.0000000000000531.
Current trends in the management of medial orbital wall fractures are toward the development of transconjunctival incisions and the use of endoscopic-assisted methods. Different authors have suggested variations of the medial transconjunctival approach.
(1) In 30 fresh cadaver orbits, the classic transcaruncular approach was compared with the precaruncular and retrocaruncular approach under magnified dissection. (2) A retrospective analysis was conducted on a series of 20 consecutive patients that underwent primary repair of medial orbital wall fractures using a retrocaruncular approach without endoscopic assistance. Postoperative computed tomography scans were obtained for all patients and were evaluated by 3 experienced clinicians.
(1) Anatomic dissections showed that all 3 approaches provided excellent exposure of the entire medial orbital wall. The transcaruncular and precaruncular approaches, however, (a) both resulted in exposure of the upper and lower tarsi when incisions greater than 10 mm were used; (b) both required a transition from the preseptal plane to the postseptal plane when combined with inferior fornix incisions. (2) A clinical study of 20 patients showed all reconstructions were possible without endoscopic assistance, resulting in no postoperative complications. Postoperative computed tomography scans showed anatomic orbital reconstruction in all patients judged as excellent by the clinicians.
Medial orbital wall fractures can be successfully repaired using transconjunctival incisions without using endoscopes. The retrocaruncular approach surpasses the transcaruncular and precaruncular methods due to its decreased risk of postoperative lid complications and its ability to be directly carried to the inferior conjunctival fornix.
目前眶内侧壁骨折的治疗趋势是采用经结膜切口并使用内镜辅助方法。不同作者提出了经结膜内侧入路的不同变体。
（1）在30个新鲜尸体眼眶中，在放大解剖下将经典的经泪阜入路与泪阜前入路和泪阜后入路进行比较。（2）对一系列连续20例采用泪阜后入路且无内镜辅助进行眶内侧壁骨折一期修复的患者进行回顾性分析。所有患者均进行了术后计算机断层扫描，并由3名经验丰富的临床医生进行评估。
（1）解剖学解剖显示，所有3种入路均能很好地暴露整个眶内侧壁。然而，经泪阜入路和泪阜前入路，（a）当切口大于10mm时，均会导致上睑板和下睑板暴露；（b）当与下穹窿切口联合使用时，两者均需要从前隔平面过渡到后隔平面。（2）对20例患者的临床研究表明，无需内镜辅助即可完成所有重建，且无术后并发症。术后计算机断层扫描显示，所有患者的眼眶解剖重建均被临床医生判定为优秀。
经结膜切口不使用内镜即可成功修复眶内侧壁骨折。泪阜后入路因其术后眼睑并发症风险降低以及能够直接延伸至下结膜穹窿，优于经泪阜入路和泪阜前入路。
