Sadek Eman Yahya, Elbarbary Amir, Safe Ikram I
Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Craniomaxillofac Trauma Reconstr. 2019 Sep;12(3):228-240. doi: 10.1055/s-0039-1677808. Epub 2019 Jan 30.
Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients' visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.
眼眶周围创伤中被忽视的损伤结构可能导致美学和功能缺陷。由于创伤可能影响浅表、中层和深层结构，因此需要依据结构化的眼眶周围创伤分类进行细致检查，以实现恰当的处理。为此，本文提出了一种新的眼眶周围创伤分类方法。眼眶周围区域通过人体测量标志进行解剖学定义。眼眶周围损伤根据解剖学和临床依据进行分类。利用这种新分类方法，对2013年7月至2016年7月在艾因夏姆斯大学医院接受治疗的眼眶周围创伤病例进行回顾性研究。该研究纳入了260例患者，其中男性196例（75.38%），女性64例（24.62%）。对损伤的类型和严重程度、初次干预时间、所施行的手术类型以及患者门诊就诊情况进行评估。对伤后及术后（初次手术）的美学状态和功能状态进行评估，并明确眼眶周围区域。眼眶周围损伤的解剖学分类包括眼周、额部、颞部和颧部区域。根据损伤深度和累及组织，将损伤/缺陷分为单纯性、复合性、复杂性和孤立性骨损伤，随后制定分类标准。在回顾性研究中，扩展性单纯损伤的发生率最高，而扩展性复杂损伤的发生率最低。24例患者（9.23%）出现功能缺陷，55例患者（21.15%）出现美学缺陷。该组患者所需进行的二次手术包括内固定修复、内眦韧带矫正、泪小管系统修复、瘢痕修复、脂肪移植以及制造自然皱襞。本研究结果表明，当重要结构损伤被忽视、美学单元未得到重视以及处理延迟时，美学和功能效果均不理想。本文提出一种基于解剖学和临床分类的三维定向眼眶周围创伤新分类方法，以帮助识别损伤结构、促使查找其他损伤、构建术前评估体系，并推荐最终能实现精确一期修复且获得最佳美学和功能效果的手术方案。
