Ramesh Sathyadeepak, Bokman Christine, Mustak Hamzah, Lo Christopher, Goldberg Robert, Rootman Daniel
Division of Orbital and Ophthalmic Plastic Surgery, UCLA Stein Eye Institute, Los Angeles, California, U.S.A.
Ophthalmic Plast Reconstr Surg. 2018 Sep/Oct;34(5):456-459. doi: 10.1097/IOP.0000000000001049.
To study whether ethmoidectomy predisposes the orbit to medial wall fracture with lesser trauma.
An interventional cadaver study of 5 heads (10 orbits); the left or right orbit was randomized to undergo endoscopic complete ethmoidectomy with the fellow orbit as control. Fractures were induced with direct globe trauma, and heads underwent CT scanning. Energy to induce fracture, peak orbital pressure at time of fracture, fracture pattern, and volume of herniated tissue were measured and analyzed.
Fractures were induced in both orbits of all cadavers. Experimental orbits after ethmoidectomy sustained orbital fracture at less energy required (2.14 ± 0.66 vs. 3.10 ± 0.19 J, mean difference: -0.96 ± 0.33 J, p < 0.05). Similarly, peak orbital pressure was lower for ethmoidectomized orbits than for controls (11.8 ± 8.42 vs. 28.4 ± 13.2 mm Hg, mean difference: -16.5 ± 6.9 mm Hg, p < 0.05). Orbits after ethmoidectomy were more likely to sustain medial wall involvement in fracture (100%) compared with controls (20%, p < 0.05) and pure medial wall fracture (80%) compared with controls (0%, p < 0.05). Overall volume of herniated orbital contents was not significantly different between groups (p = 0.25); volume of herniated tissue from the medial wall only was significantly greater in orbits after ethmoidectomy (mean difference: 1.01 ± -0.39 cm, p < 0.05).
Endoscopic ethmoidectomy in fresh cadavers reduces impact energy necessary to induce orbital fracture and increases the prevalence of medial wall involvement. Clinicians may wish to counsel patients undergoing endoscopic sinus surgery about these relative risks.
研究筛窦切除术是否会使眼眶更容易因较小创伤而发生内侧壁骨折。
对5个头部（10个眼眶）进行介入性尸体研究；将左侧或右侧眼眶随机分组，一侧眼眶接受内镜下完整筛窦切除术，另一侧眼眶作为对照。通过直接眼球创伤诱导骨折，然后对头部进行CT扫描。测量并分析诱导骨折所需的能量、骨折时的眼眶峰值压力、骨折模式以及疝出组织的体积。
所有尸体的双侧眼眶均发生骨折。筛窦切除术后的实验眼眶在较低能量下即发生眼眶骨折（2.14±0.66 vs. 3.10±0.19焦耳，平均差异：-0.96±0.33焦耳，p<0.05）。同样，筛窦切除术后眼眶的峰值眼眶压力低于对照组（11.8±8.42 vs. 28.4±13.2毫米汞柱，平均差异：-16.5±6.9毫米汞柱，p<0.05）。与对照组相比，筛窦切除术后的眼眶更易在内侧壁骨折中受累（100% vs. 20%，p<0.05），且更易发生单纯内侧壁骨折（80% vs. 0%，p<0.05）。两组间眶内容物疝出的总体积无显著差异（p = 0.25）；仅内侧壁疝出组织的体积在筛窦切除术后的眼眶中显著更大（平均差异：1.
