de Moraes Antonia Taiane Lopes, Quaresma Martha Caroline Auzier, Silva Thais Freitas, Sousa Naama Waléria Alves, Menezes Silvio Augusto Fernandes, Ribeiro Andre Luis Ribeiro, Pinheiro João de Jesus Viana
Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenue Augusto Correa, 01. Belem, Para, Brazil.
School of Dentistry, University Center of Pará (CESUPA), Belém, Pará, Brazil.
Int J Surg Case Rep. 2021 Jan;78:133-139. doi: 10.1016/j.ijscr.2020.12.011. Epub 2020 Dec 5.
Serious injuries of the globe are uncommon in closed maxillofacial trauma, as the anatomical configuration of the orbit offers important protective mechanisms against external trauma. Thus, the objective of this work is to report a case of a rare traumatic enucleation of the globe resulting from maxillofacial blunt trauma.
A 42-year-old man was hit by a car with a major complaint of facial pain. The patient had several facial fractures including: Le Fort I, naso-orbit-ethmoidal, anterior sinus wall and an exposed fracture of the orbit-zygomatic complex (OZC). The patient underwent to open reduction and internal fixation of facial fractures and enucleation of the left globe, however, evolved with postoperative infection and complications associated with, a so far unknown, type 2 diabetes. After secondary surgeries for removal infected bones and diabetes control, all injuries were fully healed, and the patient remained with major sequels.
In this case, we hypothesized a high-energy trauma resulting in multiple facial fractures, especially involving the OZC, dislocated the thick lateral wall of the orbit within the orbital cavity and reduced the orbital volume. This resulted in an exaggerated increase in intraorbital pressure, which exceeded the capacity of all anatomical protective mechanisms of the globe, and pushed the globe outwards, causing a complete avulsion.
Besides all anatomical structures to protect the globe, rarely high energy maxillofacial trauma can cause severe damage to the globe resulting in loss of vision and globe avulsion.
在闭合性颌面创伤中，眼球严重损伤并不常见，因为眼眶的解剖结构提供了重要的抵御外部创伤的保护机制。因此，本研究的目的是报告一例因颌面钝性创伤导致的罕见外伤性眼球摘除病例。
一名42岁男性被汽车撞击，主要诉面部疼痛。患者存在多处面部骨折，包括：Le Fort I型骨折、鼻眶筛骨折、前鼻窦壁骨折以及眶颧复合体（OZC）开放性骨折。患者接受了面部骨折切开复位内固定术及左眼球摘除术，然而，术后出现感染及与2型糖尿病（目前病因不明）相关的并发症。在进行了清除感染骨的二次手术及糖尿病控制后，所有损伤均完全愈合，但患者仍留有严重后遗症。
在本病例中，我们推测高能创伤导致多处面部骨折，尤其是累及OZC，使眼眶厚侧壁在眶腔内移位并减小了眶容积。这导致眶内压力过度升高，超过了眼球所有解剖保护机制的承受能力，从而将眼球向外推挤，导致完全撕脱。
尽管存在所有保护眼球的解剖结构，但高能颌面创伤仍可能罕见地导致眼球严重损伤，造成视力丧失和眼球撕脱。
