Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
J Plast Reconstr Aesthet Surg. 2023 Oct;85:195-201. doi: 10.1016/j.bjps.2023.06.071. Epub 2023 Jul 3.
To date, there have been no reports regarding the necessity or methods of reconstruction for cases where the orbital periosteum remains even though the orbital floor bone has been resected in primary reconstruction after total maxillectomy. This study investigated the reconstruction methods for infraorbital wall reconstruction in patients with residual orbital periosteum.
This was a retrospective cohort study at a single center from June 2010 to June 2019. The following two main cohorts were evaluated: non-reconstruction and reconstruction groups (reconstructed with fascia or costal cartilage) according to whether the orbital floor was reconstructed after total maxillectomy with residual orbital periosteum. The main outcomes were the deviation of the globe evaluated using computed tomography images and subjective signs of diplopia obtained from medical records.
Enophthalmos occurred in all five cases in the non-reconstruction group, and diplopia appeared in four cases. In five out of six cases in the reconstruction group, deviation of the globe was not observed. Exophthalmos occurred in one case reconstructed with costal cartilage. Diplopia was not observed in the reconstruction group. In the statistical assessment, a significant difference was observed in the globe deviation between the two groups (P = 0.004).
In cases where the orbital periosteum remains, it is necessary to actively reconstruct the infraorbital wall. Moreover, we believe that the reconstruction with fascia is convenient and useful because it is less invasive, the surgical procedure is simple, and the fascia can be collected from the same surgical field when the flap is elevated.
4 (retrospective cohort study).
迄今为止，在全上颌骨切除术后初次重建时，即使眶底骨已切除，但眶骨膜仍保留，对于是否需要重建以及如何重建，尚无相关报道。本研究旨在探讨眶骨膜保留的患者眶下壁重建的方法。
这是一项单中心回顾性队列研究，时间为 2010 年 6 月至 2019 年 6 月。根据是否在全上颌骨切除术后眶底骨膜保留的情况下重建眶底，将患者分为非重建组和重建组（用筋膜或肋软骨重建）。主要结局是通过 CT 图像评估眼球偏移和从病历中获得的复视主观体征。
非重建组 5 例均发生眼球内陷，4 例出现复视。重建组 6 例中有 5 例眼球无偏移。1 例用肋软骨重建的患者出现眼球突出。重建组未观察到复视。在统计学评估中，两组眼球偏移差异有统计学意义（P=0.004）。
眶骨膜保留时，有必要积极重建眶下壁。此外，我们认为筋膜重建更方便、更有用，因为它的侵袭性更小，手术过程更简单，而且在掀起皮瓣时可以从同一手术区域采集筋膜。
4（回顾性队列研究）。
