From the Divisions of Plastic and Reconstructive Surgery.
Pediatric Neurosurgery, Nicklaus Children's Hospital.
Plast Reconstr Surg. 2024 Aug 1;154(2):402-412. doi: 10.1097/PRS.0000000000010857. Epub 2023 Jun 20.
Vertical orbital dystopia (VOD) results in significant facial asymmetry, psychological distress, and poor quality of life in affected patients. The traditional approach (TA) for surgical correction has entailed a standard frontal craniotomy along with circumferential orbital osteotomy, vertical translocation of the orbit, and bone grafting to the lower maxilla. Caution has been expressed regarding its invasive transcranial nature. In this report, the authors describe the limited approach (LA) for simplified surgical correction of VOD, which obviates the need for a standard frontal craniotomy.
A 45-year retrospective review was conducted of all patients who underwent surgical correction of VOD, as performed by a single surgeon. Demographic details, procedural characteristics, and complications were compared between patients who underwent correction by the TA and those who underwent correction by the LA. Complications were defined as cerebrospinal fluid leak, infection of the frontal bone, permanent diplopia, permanent ptosis, sudden-onset vision loss, persistent asymmetry, and surgical revision.
Forty patients met inclusion criteria for correction of true VOD, of which 18 underwent the TA and 22 underwent the LA. Mean length of hospital stay was 5.3 ± 2.3 days and 4.0 ± 1.5 days for the TA and LA cohorts, respectively. Mean follow-up time was 4.9 ± 7.5 years for the TA cohort and 2.6 ± 3.3 years for the LA cohort. The only reported complications were persistent asymmetry in 2 patients in the TA cohort, with 1 patient requiring surgical revision because of undercorrection, whereas the LA cohort exhibited no postoperative asymmetry or need for surgical revision.
Both the TA and the LA are effective for surgical correction of VOD. The limited craniotomy of the LA reduces exposure of intracranial structures and adequately achieves postoperative symmetry.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
垂直性眼眶偏位（VOD）可导致受影响患者出现显著的面部不对称、心理困扰和生活质量下降。传统的手术矫正方法（TA）需要进行标准的额颅切开术，同时进行眶周骨切开术、眼眶垂直移位和下颌骨植骨。该方法具有明显的颅穿透性，因此存在一定的风险。在本报告中，作者描述了一种简化 VOD 手术矫正的有限入路（LA）方法，该方法无需进行标准的额颅切开术。
对一位医生施行的所有 VOD 手术矫正患者进行了一项 45 年的回顾性研究。比较了 TA 组和 LA 组患者的人口统计学特征、手术特点和并发症。并发症定义为脑脊液漏、额骨感染、永久性复视、永久性上睑下垂、突发性视力丧失、持续性不对称和手术修正。
40 例患者符合真性 VOD 矫正标准，其中 18 例行 TA，22 例行 LA。TA 组和 LA 组的平均住院时间分别为 5.3±2.3 天和 4.0±1.5 天。TA 组的平均随访时间为 4.9±7.5 年，LA 组为 2.6±3.3 年。TA 组仅报告了 2 例持续性不对称，其中 1 例因矫正不足需要手术修正，而 LA 组无术后不对称或需要手术修正。
TA 和 LA 均能有效矫正 VOD。LA 的有限颅切开术减少了对颅内结构的暴露，术后能获得足够的对称性。
临床问题/证据水平：治疗性，III 级。
