Bernardini Francesco P, Nerad Jeffrey, Fay Aaron, Zambelli Alessandra, Cruz Antonio Augusto V
*Oculoplastica Bernardini, Genova, Italy; †Cincinnati Eye Institute, Cincinnati, Ohio, USA; ‡Harvard Medical School, Boston, Massachusetts, USA; §Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Ophthalmic Plast Reconstr Surg. 2017 Mar/Apr;33(2):93-100. doi: 10.1097/IOP.0000000000000659.
To review common surgical approaches to the orbital floor and to evaluate the utility of canthal-sparing, single incision transconjunctival method.
A retrospective chart review of a consecutive series of patients who underwent transconjunctival, direct incision surgery without eyelid dissection or lateral canthotomy and inferior cantholysis and review of the literature were conducted.
Twenty-three consecutive patients (33 orbits) were operated using a canthal-sparing direct single cut approach, including 10 unilateral pediatric orbital floor fractures, 1 orbital floor implant removal, 2 unilateral post-traumatic enophthalmos repairs, and 10 bilateral orbital floor decompressions. Surgical exposure was adequate to complete the surgical objective in each patient. Mean follow up was 13 months and no complications were observed.
The transconjunctival approach to the orbital floor can be performed using a pre- or post-septal dissection, with infratarsal or fornix incision commonly associated with lateral canthotomy and inferior cantholysis. The direct approach spares the lateral canthus, minimizes lower eyelid dissection, and provides rapid and effective access to the inferior orbital rim and orbital floor. It offers sufficient exposure to allow insertion of large floor implants even in children. Although apparently abandoned in the recent literature, canthal-sparing technique is a useful method for the management of orbital floor fractures, enophthalmos correction, implant removal, and orbital decompression.
回顾眶底常见的手术入路，并评估保留内眦、单切口经结膜入路的实用性。
对一系列连续接受经结膜直接切口手术且未进行眼睑分离或外眦切开及下眦松解的患者进行回顾性病历分析，并复习相关文献。
连续23例患者（33只眼眶）采用保留内眦直接单切口入路进行手术，包括10例单侧儿童眶底骨折、1例眶底植入物取出、2例单侧外伤性眼球内陷修复以及10例双侧眶底减压术。手术暴露足以完成每位患者的手术目标。平均随访13个月，未观察到并发症。
眶底经结膜入路可采用睑板前或睑板后分离，睑板下或穹窿部切口通常与外眦切开及下眦松解相关。直接入路可保留外眦，减少下睑分离，并能快速有效地进入眶下缘和眶底。即使在儿童患者中，它也能提供足够的暴露以便插入大型眶底植入物。尽管在近期文献中似乎已被摒弃，但保留内眦技术仍是处理眶底骨折、眼球内陷矫正、植入物取出及眶减压的一种有用方法。
