Saha Asok Kumar, Samaddar Saikat, Kumar Amit, Chakraborty Arup, Deb Biplab
Department of ENT, M.G.M. Medical College and L.S.K. Hospital, Kishanganj, Bihar India.
Department of ENT, Purulia Government Medical College and Hospital, Purulia, West Bengal India.
Indian J Otolaryngol Head Neck Surg. 2019 Dec;71(4):542-549. doi: 10.1007/s12070-019-01724-9. Epub 2019 Aug 10.
Maxillofacial trauma, a common injury in urban population following road traffic accident or act of interpersonal violence of which orbital floor fractures is common. It impairs the integrity of the extraocular muscles and may be accompanied by enophthalmos, orbital deformity and diplopia. Orbital reconstruction is essential to improve anatomical and visual deformity. Repair of orbital floor is done by autologous bone graft or synthetic implants. Compare outcome of orbital floor reconstruction in blow out orbital fracture using autogenous bone graft from iliac crest, outer table of mandible, alloplastic implant- silastic block and titanium mesh. 30 patients having orbital fractures were considered in study population. All the patients were treated by ORIF and repair of floor by subcilliary incision. Out of 30 patients, repair of orbital floor was done by autologous bone graft from iliac crest in 7 patients (Group A), bone graft from outer table of mandible in 5 patients (Group B), implant using silastic block in 8 patients (Group C) and titanium mesh in 10 patients (Group D). Factors analyzed were age, sex, cause of fracture and treatment outcome in terms of correction of pre operative diplopia and enophthalmos, rate of development of post operative infection, wound dehiscence and implant exposure. All patents were reviewed at 4 weeks and 12 weeks following operation. 71.42% of patients in Group A had early correction of diplopia and enophthalmos. This was 100% in rest of the groups. All patients had complete correction when assessed at 12 weeks post operatively. Post operative complication rate was 20% and 12.5% in Group B and C respectively. There were no complications in the rest of the groups within the follow up period. No statistically significant difference as to the chance of occurrence of complication could be found amongst the groups. Autologous bone graft has no immunological reaction but donor site morbidity. Silastic block may case immunological reaction, infection, poor drainage of orbital floor. But titanium mesh for orbital floor repair has excellent outcome and superior to other modality of treatment.
颌面创伤是城市人群中交通事故或人际暴力行为后常见的损伤，其中眶底骨折很常见。它会损害眼外肌的完整性，并可能伴有眼球内陷、眼眶畸形和复视。眼眶重建对于改善解剖和视觉畸形至关重要。眶底修复可通过自体骨移植或合成植入物进行。比较使用来自髂嵴、下颌骨外板的自体骨移植、异体植入物（硅橡胶块）和钛网进行爆裂性眶骨折眶底重建的结果。研究人群包括30例眶骨折患者。所有患者均接受切开复位内固定术，并通过睫下切口修复眶底。在30例患者中，7例患者（A组）采用来自髂嵴的自体骨移植修复眶底，5例患者（B组）采用来自下颌骨外板的骨移植，8例患者（C组）使用硅橡胶块植入，10例患者（D组）使用钛网。分析的因素包括年龄、性别、骨折原因以及治疗结果，治疗结果涉及术前复视和眼球内陷的矫正、术后感染、伤口裂开和植入物暴露的发生率。所有患者在术后4周和12周进行复查。A组71.42%的患者早期复视和眼球内陷得到矫正。其他组为100%。术后12周评估时所有患者均完全矫正。B组和C组的术后并发症发生率分别为20%和12.5%。随访期间其他组无并发症。各组之间并发症发生几率无统计学显著差异。自体骨移植无免疫反应，但存在供区并发症。硅橡胶块可能引发免疫反应、感染、眶底引流不畅。但用于眶底修复的钛网效果极佳，优于其他治疗方式。
