Imaizumi Atsushi, Ishida Kunihiro, Nishizeki Osamu
Department of Plastic Surgery, Prefectural Okinawa Chubu Hospital, Aza Miyazato 281, Uruma City, Okinawa, 904-2243, Japan.
Department of Plastic Surgery, Prefectural Okinawa Chubu Hospital, Aza Miyazato 281, Uruma City, Okinawa, 904-2243, Japan.
J Craniomaxillofac Surg. 2016 Dec;44(12):1922-1928. doi: 10.1016/j.jcms.2016.09.006. Epub 2016 Sep 23.
Recent advancements in computed tomography have enabled the diagnosis of naso-orbito-ethmoid (NOE) fractures to be made in much greater detail. Surgical access to the upper nasofrontal buttress in NOE fractures, however, has remained unchanged over the past decades. All approaches to these fractures using skin incisions have individual drawbacks. The transcaruncular approach is free of the drawbacks of the cutaneous approaches. We further extended the transcaruncular approach for the treatment of NOE and Le Fort II fractures.
Eight patients; six with Markowitz's Type I NOE fractures and two with Le Fort II fractures, underwent fracture repair using an extended transcaruncular approach to access the upper nasofrontal buttress.
In all but one case, which required an additional small skin incision on the glabella, the fracture on the upper nasofrontal buttress was repaired through an extended transcaruncular approach without making any skin incisions. All showed excellent fracture re-alignment on post-surgical CT. Complications happened in three cases; those in two cases were attributed to the extended transcaruncular approach, whereas those in the other were not.
The extended transcaruncular approach is a promising alternative to current conventional approaches for NOE and Le Fort II fractures, achieving accurate repair without the need for skin incision.
计算机断层扫描技术的最新进展使得鼻眶筛（NOE）骨折的诊断能够更加详细。然而，在过去几十年中，NOE骨折中上鼻额支柱的手术入路并未改变。所有使用皮肤切口治疗这些骨折的方法都有各自的缺点。经泪阜入路没有皮肤入路的缺点。我们进一步扩展了经泪阜入路用于治疗NOE骨折和Le Fort II型骨折。
8例患者，其中6例为Markowitz I型NOE骨折，2例为Le Fort II型骨折，采用扩展经泪阜入路进入上鼻额支柱进行骨折修复。
除1例在眉间需要额外做一个小皮肤切口外，其余所有患者均通过扩展经泪阜入路修复上鼻额支柱骨折，未做任何皮肤切口。术后CT显示所有患者骨折复位良好。3例出现并发症；2例并发症归因于扩展经泪阜入路，另1例则并非如此。
扩展经泪阜入路是目前治疗NOE骨折和Le Fort II型骨折传统方法的一种有前景的替代方法，无需皮肤切口即可实现精确修复。
