Department of Odontostomatological and Maxillofacial Sciences, "La Sapienza University of Rome," Rome, Italy.
J Craniofac Surg. 2023;34(8):e753-e757. doi: 10.1097/SCS.0000000000009629. Epub 2023 Aug 25.
Orbital fractures are among the most frequent facial injuries. Of the 3 most widely described approaches in the literature, the lower eyelid approach is the authors' preference. This study retrospectively analyzed the patients treated at the Trauma Center of the Umberto I Hospital, Sapienza University of Rome from January 2010 to December 2020. Inclusion criteria were as follows: diagnosis of pure/impure orbital bone fracture, complete clinical and radiological documentation, and a minimum of 12 months follow-up. Sex, age, etiology, treatment, and associated complications were analyzed using IBM SPSS Statistics. Two internationally validated scales were used for the functional and esthetic long-term evaluation: the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver one. The scales were compiled by the patient himself and by 3 independent expert observers. Of the 543 patients who underwent surgery in the specified period, 208 fully met the inclusion criteria. One hundred forty-two (68.2%) were males and 66 (31.8%) were females, with a mean age of 40.68 years. The main cause was represented by assaults (33.1%). One hundred seventy-nine patients had a pure orbital fracture (83.8%) and 29 an impure one (16.2%). The most frequent symptoms at the time of diagnosis were diplopia (31.2%), followed by anesthesia of the second trigeminal branch (24.3%). Open reduction with internal fixation was the preferred treatment and proved to be effective in reducing the main signs and symptoms of the fracture in a statistically significant way ( P < 0.05). Long-term esthetic results of the lower eyelid, using the Vancouver and POSASs, were respectively as follows: Vancouver Scar Scale mean total score was 2.41 (range: 0-8), observer POSAS mean total score was 1.83 (range: 1.2-3.9), observer general opinion mean score was 1.66, patient POSAS mean total score was 2.23 (range: 1.33-3.7), and patient general opinion mean score was 2.87. The lower eyelid approach has proven to be reproducible, with a fast-learning curve and a low complication rate. The analysis conducted highlighted an excellent long-term esthetic-functional result. Further studies will be needed to statistically compare the results obtained with other orbital floor surgical approaches.
眼眶骨折是最常见的面部损伤之一。在文献中广泛描述的 3 种方法中，下眼睑入路是作者的首选。本研究回顾性分析了 2010 年 1 月至 2020 年 12 月在罗马萨皮恩扎大学翁贝托一世医院创伤中心治疗的患者。纳入标准如下：单纯/不纯眶骨骨折的诊断、完整的临床和影像学记录以及至少 12 个月的随访。使用 IBM SPSS Statistics 分析性别、年龄、病因、治疗和相关并发症。使用两种国际上经过验证的量表对功能和美观进行长期评估：患者和观察者疤痕评估量表（POSAS）和温哥华量表。这些量表由患者本人和 3 名独立的专家观察员编制。在指定期间接受手术的 543 名患者中，有 208 名完全符合纳入标准。142 名（68.2%）为男性，66 名（31.8%）为女性，平均年龄为 40.68 岁。主要原因是袭击（33.1%）。179 名患者为单纯眼眶骨折（83.8%），29 名患者为复合性眼眶骨折（16.2%）。诊断时最常见的症状是复视（31.2%），其次是第二三叉神经分支麻醉（24.3%）。切开复位内固定是首选的治疗方法，在统计学上显著降低了骨折的主要体征和症状（P < 0.05）。下眼睑的长期美学结果，使用温哥华和 POSAS 评估，分别为：温哥华瘢痕量表总评分平均为 2.41（范围：0-8），观察者 POSAS 总评分平均为 1.83（范围：1.2-3.9），观察者总体意见平均评分为 1.66，患者 POSAS 总评分平均为 2.23（范围：1.33-3.7），患者总体意见平均评分为 2.87。下眼睑入路已被证明是可重复的，具有快速学习曲线和低并发症发生率。分析结果表明，该方法具有优异的长期美观-功能效果。需要进一步的研究来统计比较与其他眶底手术入路获得的结果。
