Jeon Jae Hyung, Jeon Hong Bae, Kim Hyonsurk, Kang Dong Hee
Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Korea.
Arch Craniofac Surg. 2025 Feb;26(1):5-12. doi: 10.7181/acfs.2024.00542. Epub 2025 Feb 20.
Orbital medial wall fractures, which are more common than inferior wall fractures, have traditionally been difficult to diagnose with conventional radiography. As the fracture extends deep into the bony orbit, accurately visualizing internal structures becomes challenging, increasing the risk of optic nerve compression. In a previous study, the author introduced a technique for treating medial orbital wall fractures using a combined transethmoidal and transcaruncular approach. In this study, the authors hypothesized that the use of surgical navigation could enhance precision, safety, and anatomical reconstruction in this approach and employed navigation during surgery for medial orbital wall fractures and evaluated whether it improved postoperative functional and anatomical outcomes while minimizing complications.
From September 2021 to November 2023, 48 patients with isolated medial wall fractures underwent surgical treatment using a combined transcaruncular approach and transethmoidal packing to repair the orbital fracture. Of these patients, 23 underwent surgery with the use of intraoperative navigation, while the other 25 did not. Intraoperative navigation was employed to facilitate precise fracture reduction and reduce the risk of optic nerve injury. The outcomes were compared by dividing the patients into two groups. Preoperative and postoperative assessments included ophthalmologic evaluations, Hertel exophthalmometry, and computed tomography-based orbital volume measurements.
The surgical approach with intraoperative navigation was successfully performed in all patients. Postoperative outcomes showed full recovery without residual symptoms or complications. Orbital volume measurements indicated a significant reduction in the preoperative orbital volume ratio from 109.03% to 104.80% postoperatively (p< 0.001). However, changes in the Hertel scale were not statistically significant (p = 0.086).
The integration of intraoperative navigation in medial orbital wall fracture surgery enhances the precision of medial orbital wall restoration and minimizes postoperative complications, supporting its use in the surgical management of medial orbital fractures.
眼眶内侧壁骨折比下壁骨折更常见，传统上使用传统放射照相术难以诊断。由于骨折深入眼眶骨内，准确观察内部结构具有挑战性，增加了视神经受压的风险。在先前的一项研究中，作者介绍了一种使用经筛窦和经泪阜联合入路治疗眼眶内侧壁骨折的技术。在本研究中，作者假设使用手术导航可提高该入路的精确性、安全性和解剖重建效果，并在眼眶内侧壁骨折手术中采用导航，评估其是否能改善术后功能和解剖学结果，同时将并发症降至最低。
2021年9月至2023年11月，48例孤立性内侧壁骨折患者采用经泪阜联合入路和经筛窦填塞术进行手术治疗以修复眼眶骨折。其中，23例患者术中使用了导航，另外25例未使用。术中使用导航以促进精确的骨折复位并降低视神经损伤风险。将患者分为两组进行结果比较。术前和术后评估包括眼科评估、Hertel眼球突出计测量以及基于计算机断层扫描的眼眶容积测量。
所有患者均成功实施了术中导航的手术方法。术后结果显示完全恢复，无残留症状或并发症。眼眶容积测量表明，术前眼眶容积比从109.03%显著降低至术后的104.80%（p<0.001）。然而，Hertel量表的变化无统计学意义（p = 0.086）。
术中导航应用于眼眶内侧壁骨折手术可提高眼眶内侧壁修复的精确性，并将术后并发症降至最低，支持其在眼眶内侧骨折手术治疗中的应用。
