Wang H Z, Lai S, Chang C H
Department of Ophthalmology, Kaohsiung Medical College, Taiwan, Republic of China.
Gaoxiong Yi Xue Ke Xue Za Zhi. 1995 Jun;11(6):359-65.
A 30 year-old male came to us for correcting his severe left enophthalmos five months after a facial trauma in a traffic accident. CT scan of his left orbit showed a greatly increased orbital volume, which was resulted from the incomplete reduction of left zygomaticomaxillary complex (ZMC) fracture, unrepaired medial and lateral walls, and improper restoration of the orbital floor with a silicone sheet. Also, the decreased ocular volume, due to the evisceration of the ruptured eyeball with intraocular silicone ball implantation, contributed to the patient's enophthalmos. Because the patient refused any kind of osteotomy for his incompletely reduced and malunion ZMC fracture in the procedures of orbital reconstruction, correction of his severe enophthalmos became very difficult if not impossible. Therefore, we used a piece of titanium mesh plate about 2.5 x 4 cm in size, and folded it into an L shape. The shorter part of the L-shaped plate was used to fix the whole plate by screwing it into the anterior surface of the inferior orbital rim. The longer part of the plate was used as a new orbital floor. To hold and push the intraocular implant upward and anteriorly, the longer part of the plate was adjusted to a level higher than the original floor level, and was bent upward gently in the posterior part. Postoperatively, the severe enophthalmos was markedly improved, and the patient was satisfied although an evident supratarsal sulcus was still present. After a follow-up of 18 months, no complication of migration, infection, or extrusion of the titanium mesh plate occurred.
一名30岁男性在交通事故中面部受伤五个月后前来我院矫正严重的左眼球内陷。其左眼眶CT扫描显示眼眶容积显著增大，这是由于左侧颧骨上颌复合体（ZMC）骨折复位不完全、内外侧壁未修复以及用硅胶片对眶底进行了不恰当的修复所致。此外，由于破裂眼球摘除并植入眼内硅胶球导致眼内容积减小，这也加重了患者的眼球内陷。由于患者在眼眶重建过程中拒绝针对其复位不完全且畸形愈合的ZMC骨折进行任何截骨手术，矫正其严重的眼球内陷即便不是不可能，也变得非常困难。因此，我们使用了一块尺寸约为2.5×4厘米的钛网板，并将其折成L形。L形板较短的部分通过拧入眶下缘前表面来固定整个板。板较长的部分用作新的眶底。为了将眼内植入物向上和向前固定并推移，将板较长的部分调整到高于原始眶底水平，并在后部轻轻向上弯曲。术后，严重的眼球内陷明显改善，尽管仍有明显的睑上沟，但患者感到满意。随访18个月后，未发生钛网板移位、感染或脱出等并发症。
