Park Tae Hwan
Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea.
J Craniofac Surg. 2024 Feb 14. doi: 10.1097/SCS.0000000000010034.
The orbit is a confined space with a defined bony structure. Bony protrusion into the ethmoid or maxillary sinuses by the blowout fracture can displace orbital tissues, including rectus muscles and adjacent fascial septae. Especially, reconstructing the orbit's floor and medial wall can be challenging when the inferomedial strut or posterior bony ledge is affected, leading to a loss of critical anatomic landmarks and support. Correctly positioning an implant in the precise anatomic location can be challenging. Recent updates to the navigation system have addressed this issue. Despite its early application, using a navigation system in these orbital fractures advances plastic surgeons in a way that has more confidence and accuracy in surgical planning. The video demonstrates how these 2 can be combined in an operating room. Intraoperatively, the authors check the superior, anterior, and posterior ends of the medial wall fracture and the posterior end of the floor fracture. A single orbital implant was trimmed and reshaped to match defect measurements. The implant placement was meticulously executed to repair the fracture while ensuring the inferior oblique muscle was not injured. After confirming the correct placement of the implant, it was secured to the inferior orbital rim using a single screw. Depending on the medial orbital wall fracture depth or degree of soft tissue herniation, the authors used an artificial dermal matrix or trimmed absorbable mesh plate to cover the uppermost part of the medial wall fracture to prevent postoperative enophthalmos. Finally, a forced duction test was performed. Our study shows that navigation-assisted inferomedial orbital wall reconstruction using materials readily available in the market is safe and effective.
眼眶是一个具有明确骨性结构的受限空间。爆裂性骨折导致的骨性结构突入筛窦或上颌窦可使眼眶组织移位，包括直肌和相邻的筋膜隔。特别是当眶内下支柱或后骨性边缘受到影响时，重建眶底和眶内壁具有挑战性，这会导致关键解剖标志和支撑结构的丧失。将植入物精确放置在准确的解剖位置可能具有挑战性。导航系统的最新进展解决了这一问题。尽管其应用较早，但在这些眼眶骨折中使用导航系统使整形外科医生在手术规划方面更有信心和准确性。视频展示了这两者如何在手术室中结合使用。术中，作者检查了眶内壁骨折的上、前和后端以及眶底骨折的后端。对单个眼眶植入物进行修剪和塑形以匹配缺损尺寸。精心进行植入物放置以修复骨折，同时确保下斜肌未受损伤。确认植入物放置正确后，用单枚螺钉将其固定于眶下缘。根据眶内壁骨折深度或软组织疝出程度，作者使用人工真皮基质或修剪后的可吸收网片覆盖眶内壁骨折的最上部以防止术后眼球内陷。最后，进行了牵拉试验。我们的研究表明，使用市场上 readily available 的材料进行导航辅助的眶内下壁重建是安全有效的。 （注：原文中“readily available”翻译为“ readily available”，可能是想表达“现成可用的”，但英文表述有误，推测正确表述为“readily available” ）
