Beigi Bijan, Beigi Mazda, Niyadurupola Nuwan, Saldana Manuel, El-Hindy Nabil, Gupta Deepak
Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Department of Life Sciences, Brunel University, Uxbridge, United Kingdom.
Craniomaxillofac Trauma Reconstr. 2017 Mar;10(1):22-28. doi: 10.1055/s-0036-1592095. Epub 2016 Oct 17.
The purpose of this study was to present the management of a series of patients referred with infraorbital nerve paraesthesia that developed after insignificant orbital floor fracture without diplopia or exophthalmos, and that did not require initial surgical repair. This is a retrospective interventional case series. The main outcome and measures were assessment of preoperative symptoms including neuralgia and sensory symptoms; review of periorbital computed tomography (CT) scans; and assessment of postoperative effects of surgery for infraorbital nerve decompression. Nine patients were identified who developed neuralgia affecting the infraorbital nerve distribution from a cohort of 79 patients who presented with orbital floor fracture. Six were female and three were male. Age range was 22 to 73 years with a mean of 48 years. Six patients were clinically depressed due to the chronic pain. In addition, two patients had dizziness on upgaze; one patient had blurring of central vision on eye movements; and one patient had mood swings. Reviews of CT scans revealed subtle disruption of the infraorbital canal in all cases. All nine patients underwent infraorbital nerve decompression. Abnormal adhesions between the nerve and its bony canal were found in five of nine cases. Follow-up ranged from 3 to 37 months (mean: 18 months). Following surgery, after a variable period of time ranging from 1 day to 3 months, all patients had resolution of their symptoms. Mean follow-up was 18 months. Reconstructive surgeons should be aware that infraorbital nerve neuralgia, secondary to disruption of the nerve in the distorted bony canal, may be another indication for surgical intervention following orbital floor trauma in selected cases, in addition to more traditionally accepted indications. Neuralgia and causalgia are probably more common than previously thought and symptoms should be actively sought in the patient's history or else risk being overlooked and inappropriately managed. Long-term follow-up of such patients is unlikely to be practical. Patient and/or family practitioner education of possible sequelae may be one possible solution to detect this type of problem early. Nerve decompression, where indicated, may improve the patient's neuralgia and associated behavioral changes and quality of life. An optimal diagnostic and management algorithm is yet to be established.
本研究的目的是介绍一系列因眶底骨折轻微且无复视或眼球突出而无需初期手术修复，但出现眶下神经感觉异常的患者的治疗情况。这是一项回顾性干预病例系列研究。主要结局指标包括术前症状评估（包括神经痛和感觉症状）、眶周计算机断层扫描（CT）复查以及眶下神经减压手术的术后效果评估。在79例眶底骨折患者中，有9例出现了影响眶下神经分布的神经痛。其中6例为女性，3例为男性。年龄范围为22至73岁，平均年龄48岁。6例患者因慢性疼痛出现临床抑郁。此外，2例患者上视时头晕；1例患者眼球运动时中央视力模糊；1例患者情绪波动。CT复查显示所有病例眶下管均有细微破坏。所有9例患者均接受了眶下神经减压术。9例中有5例发现神经与其骨管之间存在异常粘连。随访时间为3至37个月（平均18个月）。手术后，经过1天至3个月不等的一段时间，所有患者的症状均得到缓解。平均随访时间为18个月。重建外科医生应意识到，除了更传统的公认指征外，在某些特定病例中，眶底创伤后因神经在变形骨管中受损继发的眶下神经痛可能是手术干预的另一指征。神经痛和灼性神经痛可能比以前认为的更常见，应在患者病史中积极询问相关症状，否则可能被忽视并处理不当。对这类患者进行长期随访不太可行。对患者和/或家庭医生进行可能后遗症的教育可能是早期发现这类问题的一种解决办法。在有指征的情况下进行神经减压术，可能会改善患者的神经痛及相关行为改变和生活质量。目前尚未建立最佳的诊断和治疗算法。
