Lee Geraldine Hwee Ping, Ho Samuel Yew Ming
Section of Plastic, Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Craniomaxillofac Trauma Reconstr. 2017 Mar;10(1):77-83. doi: 10.1055/s-0036-1584398. Epub 2016 Jun 23.
Orbital blowout fractures are a common occurrence following orbital trauma. Depending on the size of the defect and the contents that have herniated or incarcerated, possible sequelae include enophthalmos, diplopia, dystopia, and entrapment. Surgical intervention aims to prevent or alleviate this through the use of a bone graft or an alloplastic implant to reconstitute the continuity of the orbit. However, in doing so, the implant itself may result in the unexpected adherence of the periorbita, resulting in orbital adherence syndrome. We present two cases of orbital adherence syndrome following the use of titanium mesh for orbital floor reconstruction. In both cases, we also delineate the management of this syndrome. Our first patient reported good recovery after surgical intervention to relieve the tethering to the titanium mesh and subsequent placement of a smooth interface implant. The other patient was managed nonsurgically with resolution of symptoms. We highlight possible signs that might suggest the need for early surgical intervention. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery.
眼眶爆裂性骨折是眼眶外伤后常见的情况。根据缺损的大小以及疝出或嵌顿的内容物，可能的后遗症包括眼球内陷、复视、异位和眼球陷没。手术干预旨在通过使用骨移植或异体植入物来重建眼眶的连续性，以预防或减轻这些情况。然而，这样做时，植入物本身可能会导致眶周意外粘连，从而导致眼眶粘连综合征。我们报告了两例使用钛网进行眶底重建后出现眼眶粘连综合征的病例。在这两个病例中，我们还阐述了该综合征的处理方法。我们的首例患者在接受手术干预以解除与钛网的束缚并随后植入光滑界面植入物后，恢复良好。另一例患者通过非手术治疗症状得到缓解。我们强调了可能提示需要早期手术干预的迹象。眼眶粘连综合征是一种描述和了解较少的现象，似乎在使用大孔钛网进行眼眶重建后出现。通过仔细选择患者并在初次手术中放置光滑界面介质，可以预防该综合征。
