Lozada Kirkland N, Cleveland Patrick W, Smith Jesse E
Department of Otolaryngology Head & Neck Surgery, New York Eye & Ear Infirmary of Mount Sinai, New York, New York.
Department of Otolaryngology Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Semin Plast Surg. 2019 May;33(2):106-113. doi: 10.1055/s-0039-1685477. Epub 2019 Apr 26.
The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.
眼眶位于一个复杂的骨性结构内,其上方覆盖着软组织,涉及许多重要的解剖结构。眼眶创伤是这些结构受损的常见原因。作者回顾了关于重建技术的文献,重点关注眶缘、眶顶、眶底、眶内侧壁和鼻眶筛复合体的骨折。使用PubMed对相关主题的文章进行了全面的文献综述。使用了各种搜索词来识别关于眼眶创伤表现、诊断、治疗以及术后并发症的文章。所有作者对文章进行了审查,并收集了相关信息以撰写本综述。眼眶创伤可导致形式和功能方面的多种并发症。并非所有眼眶骨折都需要手术修复。然而,骨结构破坏可导致眼球内陷、眼球下移、睑裂增宽、溢泪、脑脊液漏、眼眶血肿,甚至失明等。手术修复的时机以及重建方法取决于患者的个体表现。成功的骨折治疗需要对解剖结构和病理生理有详细的了解,以确保恢复患者的术前状态。眼眶创伤包括多种损伤机制和由此产生的骨折类型。如前所述,存在多种眼眶手术入路,使外科医生能够进入所有感兴趣的区域。无论骨折的复杂性如何,无创伤技术、解剖复位和稳定固定的原则适用于所有病例。