Nguyen Dennis C, Shahzad Farooq, Snyder-Warwick Alison, Patel Kamlesh B, Woo Albert S
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Craniomaxillofac Trauma Reconstr. 2016 Mar;9(1):46-54. doi: 10.1055/s-0035-1563390. Epub 2015 Aug 19.
We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular-transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular-transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular-transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm(2); the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm(2). Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular-transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest).
我们评估经泪阜入路修复眶内侧壁骨折以及经泪阜 - 结膜联合入路修复累及内侧壁和眶底的大型眶缺损的安全性和有效性。对2007年6月至2013年6月间由同一位外科医生采用经泪阜入路或经泪阜 - 结膜联合入路治疗眼眶骨折的患者的临床和影像学资料进行回顾性分析。7例孤立性眶内侧壁骨折患者采用经泪阜入路，9例合并眶内侧壁和眶底骨折患者采用经泪阜 - 结膜联合入路并外眦切开术。使用多孔聚乙烯植入物进行修复。所有孤立性眶内侧壁骨折患者均有眼球内陷。在合并眶内侧壁和眶底骨折组中，8例患者中有5例存在眼球内陷，其中2例还伴有眼球下移。术前计算机断层扫描（CT）显示眶内侧壁缺损大小为2.6至4.6平方厘米；合并眶内侧壁和眶底骨折的缺损大小为4.5至12.7平方厘米。在11例进行术后CT扫描的患者中，所有患者植入物位置均良好。所有患者的眼球内陷和眼球下移均得到矫正。记录到1例并发症，术后2天发生球后血肿。经泪阜入路是修复眶内侧壁骨折的一种安全有效的方法。即使是累及眶内侧壁和眶底的大型骨折，采用经泪阜 - 结膜 - 外眦切开联合入路也能充分暴露并进行修复。本研究的证据级别为IV级（前后测试的病例系列）。
