Suzuki Motohiko, Nakamura Yoshihisa, Ozaki Shinya, Yokota Makoto, Murakami Shingo
Department of Otorhinolaryngology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
J Craniofac Surg. 2017 Jun;28(4):998-1002. doi: 10.1097/SCS.0000000000003535.
Endoscopic approach provides excellent magnification and visualization, and a purely transnasal approach is minimally invasive method. However, it is very difficult to repair anterior and lateral fractures with the previous transnasal endoscopic approaches, since repair of orbital fractures is managed through the middle meatus and ostium from the posterior side of the nasolacrimal duct with side-viewing endoscope and curved instruments. Therefore, the authors used modified transnasal endoscopic approach as an alternative for repair of orbital floor fractures in order to effectively reach the lateral or anterior fracture of the orbital floor with straight endoscope and instruments endoscopically.
Modified transnasal endoscopic approach through anterior space to nasolacrimal duct was performed in patients with orbital floor fracture, when patients rejected extranasal approach and reconstruction could not be performed by the previous purely transnasal endoscopic approach. After removal of the medial maxillary bone, the lateral wall of nose was shifted in the medial direction to allow wider access to the maxillary sinus. The bone fragments entrapping the orbital content are removed carefully, and correction of periorbita is performed. After surgery, patients were asked whether they have symptoms and/or complications.
This modified approach was performed in 15 patients (10 males and 5 females). Mean age at surgery was 37.6 years with a range between 17 and 67. Double vision disappeared in all patients.
This novel approach appears to be a safe and effective technique for the repair of orbital floor fractures.
内镜入路可提供极佳的放大效果和视野，而单纯经鼻入路是一种微创方法。然而，以往的经鼻内镜入路很难修复眼眶前部和外侧骨折，因为眼眶骨折的修复需通过中鼻道和鼻泪管后侧的开口，使用侧视内镜和弯曲器械来进行。因此，作者采用改良经鼻内镜入路作为修复眶底骨折的替代方法，以便能使用直内镜和器械在内镜下有效抵达眶底的外侧或前部骨折处。
对于眶底骨折患者，当患者拒绝鼻外入路且以往的单纯经鼻内镜入路无法进行重建时，采用经鼻内镜通过鼻泪管前方间隙的改良入路。去除上颌骨内侧骨质后，将鼻侧壁向内移位，以获得更宽敞的上颌窦入路。小心去除嵌顿眼眶内容物的骨碎片，并对眶周进行矫正。术后询问患者是否有症状和/或并发症。
15例患者（男10例，女5例）采用了这种改良入路。手术平均年龄为37.6岁，范围在17至67岁之间。所有患者复视均消失。
这种新方法似乎是一种修复眶底骨折安全有效的技术。
