Soejima Kazutaka, Kashimura Tsutomu, Yamaki Takashi, Sakurai Hiroyuki, Nakazawa Hiroaki
*Department of Plastic and Reconstructive Surgery, Nihon University School of Medicine †Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
J Craniofac Surg. 2017 Jun;28(4):1013-1016. doi: 10.1097/SCS.0000000000003742.
Endonasal endoscopic repair of medial orbital wall fractures is minimally invasive and benefits the patients. The authors describe the authors' modified balloon technique, which allows longer support of the orbital wall. From October 2010 through January 2016, the author repaired 9 isolated medial wall fractures by this method. Five patients were diagnosed as having enophthalmos of greater than 2 mm, and 6 patients had persistent diplopia before the operation. The herniated orbital contents that filled the anterior ethmoidal sinus were gently reduced with a 4-mm-diameter 0° sinus endoscope. Then a posterior nasal cavity balloon (Type B # 32014, KOKEN Co, Japan) was inserted into the ethmoidal sinus and filled with normal saline. The inflation tube of the balloon was sutured to the nasal cavity wall with absorbable sutures. After checking the status of the balloon, the inflation tube was ligated and cut so that it could be hidden inside the nasal cavity. The balloon was removed on an outpatient basis 6 to 7 weeks after the surgery. In this series, the mean inflation volume of the balloon was 1.6 mL, the mean period of leaving the balloon in place was 5.7 weeks, and the mean operative time was 38.6 minutes.Resolution of the preoperative diplopia and enophthalmos was achieved in all 9 patients, and there was no recurrence of prolapse of the orbital contents. This method allows leaving the balloon in place for a long period of time without interfering with daily life, which reduces the risk of rebulging of the orbital contents.
鼻内镜下眶内侧壁骨折修复术具有微创性，对患者有益。作者描述了其改良的球囊技术，该技术可对眶壁提供更长时间的支撑。从2010年10月至2016年1月，作者采用该方法修复了9例孤立性内侧壁骨折。5例患者诊断为眼球内陷大于2毫米，6例患者术前存在持续性复视。使用直径4毫米的0°鼻窦内窥镜将填充在前筛窦的疝出眶内容物轻轻复位。然后将后鼻腔球囊（型号B # 32014，日本光研株式会社）插入筛窦并注入生理盐水。球囊的充气管用可吸收缝线缝合至鼻腔壁。检查球囊状态后，结扎并剪断充气管，使其可藏于鼻腔内。术后6至7周在门诊取出球囊。在该系列中，球囊的平均注入量为1.6毫升，球囊留置的平均时间为5.7周，平均手术时间为38.6分钟。所有9例患者术前的复视和眼球内陷均得到解决，且眶内容物脱垂无复发。该方法可使球囊长时间留置而不影响日常生活，降低了眶内容物再次膨出的风险。
