Chen Chien-Tzung, Pan Chun-Hao, Chen Chih-Hao, Shyu Victor Bong-Han, Wu John Chung-Han, Kang Gavin Chun-Wui
Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
J Plast Reconstr Aesthet Surg. 2018 Jan;71(1):90-100. doi: 10.1016/j.bjps.2017.08.018. Epub 2017 Aug 24.
Sequelae of inadequate orbital reconstruction include enophthalmos, hypoglobus, and diplopia. Accuracy of orbital reconstruction is largely subjective and especially difficult to achieve because of anatomic distortion in secondary or late reconstruction and in extensive injury. We combined computer navigation and endoscopy to perform accurate, aesthetic, and safe minimal-access primary and secondary orbital reconstruction.
From 2013 to 2014, 24 patients underwent unilateral primary and secondary or late minimally invasive orbital reconstruction with mainly Medpor and/or titanium mesh by navigation and endoscopic assistance through transantral, transconjunctival, or upper blepharoplasty approaches. Mean follow-up was 13.8 months (range, 6.2 months to 2.8 years).
All orbital fractures were successfully reduced. Average enophthalmos among patients who underwent early reconstruction, late reconstruction, and multiorbital wall repair improved (p < .001) to 0.2 mm from 1.6, 2.6, and 2.6 mm, respectively. Hypoglobus and diplopia resolved in all. In early reconstruction patients, mean interorbital volume difference improved from 1.72 ± 0.87 to 0.53 ± 0.83 ml (P = .03). For late reconstruction patients, this difference improved from 3.41 ± 1.23 to 0.56 ± 0.96 ml (p < .001). There were no major complications during follow-up, and all were satisfied with their final appearance and function.
Navigation sharpens reconstructive accuracy and avoids injury to vital structures. Combined with endoscopic assistance for minimal-access reconstruction of wide-ranging orbital defects from primary to secondary or late cases and to extensive multiwall fractures, navigation facilitates minimal cosmetic incision and synergistic endoscope use and clearly optimizes aesthetic and functional outcomes, all with enhanced safety and unparalleled intraoperative visualization.
眼眶重建不足的后遗症包括眼球内陷、眼球下移和复视。眼眶重建的准确性很大程度上是主观的，由于二次或晚期重建以及广泛损伤中的解剖结构变形，尤其难以实现。我们将计算机导航和内窥镜检查相结合，以进行准确、美观且安全的微创一期和二期眼眶重建。
2013年至2014年，24例患者通过经鼻窦、经结膜或上睑成形术入路，在导航和内窥镜辅助下，主要使用Medpor和/或钛网进行单侧一期和二期或晚期微创眼眶重建。平均随访时间为13.8个月（范围为6.2个月至2.8年）。
所有眼眶骨折均成功复位。早期重建、晚期重建和多眶壁修复患者的平均眼球内陷分别从1.6、2.6和2.6毫米改善（p <.001）至0.2毫米。眼球下移和复视均得到解决。在早期重建患者中，平均眶间容积差异从1.72±0.87毫升改善至0.53±0.83毫升（P =.03）。对于晚期重建患者，这一差异从3.41±1.23毫升改善至0.56±0.96毫升（p <.001）。随访期间无重大并发症，所有患者对最终外观和功能均满意。
导航提高了重建的准确性，避免了对重要结构的损伤。结合内窥镜辅助，用于从一期到二期或晚期病例以及广泛的多壁骨折的大范围眼眶缺损的微创重建，导航有助于最小化美容切口和协同使用内窥镜，并明显优化美学和功能结果，所有这些都提高了安全性并提供了无与伦比的术中可视化效果。
