Ferreira J C, Ramos R R, Gomes Filho W R, Simomoto P L, Andrews J de M
Disciplina de Cirurgia Plástica da Escola Paulista e Medicina, Säo Paulo.
Rev Assoc Med Bras (1992). 1994 Jul-Sep;40(3):207-10.
Patients with orbital fractures may develop late complications like enophthalmos, orbital dystopia or diplopia, as a result of untreated orbital floor lesions, with herniation of orbital fat. Clinical and radiological findings are not enough for diagnostic and indication of orbital floor repair.
To evaluate the indication of repair of the orbital floor, during the surgical treatment of maxillozygomatic or zygomatic-maxillary compound fractures, by means of systemic exploration and to compare clinical with surgical findings.
112 patients with unilateral zygomatic-maxillary compound fracture were submitted to exploration of the orbital floor, during the surgical treatment of the fracture. Open reduction and rigid internal fixation was performed with steel wire or miniplates. An autogenous conchal cartilage graft was used to repair the floor lesion, when there was bone loss of the inferior orbital wall and periorbita discontinuity, with fat herniation.
The repair of the orbital floor was indicated in 46.4% of the patients. Early diplopia (before surgery) was observed in 26.6% and enophthalmos in 3.30% of the cases. Among patients with early diplopia, 60% needed repair, while 36.6% of the patients without early diplopia received cartilage graft. No important complications was observed.
Orbital floor exploration is a complementary maneuver for the treatment of zygomatic-maxillary compound fractures that permits the precise diagnostic of the lesion and the correct indication of repair.
眼眶骨折患者可能会因未治疗的眶底病变伴眶脂肪疝出而出现眼球内陷、眼眶移位或复视等晚期并发症。临床和影像学检查结果不足以用于眶底修复的诊断和指征判断。
通过系统探查评估在治疗上颌骨颧突或颧上颌复合骨折的手术过程中眶底修复的指征，并比较临床检查结果与手术探查结果。
112例单侧颧上颌复合骨折患者在骨折手术治疗过程中接受了眶底探查。采用钢丝或微型钢板进行切开复位和坚固内固定。当下眶壁骨质缺损且眶周组织连续性中断伴有脂肪疝出时，使用自体耳甲软骨移植修复眶底病变。
46.4%的患者需要进行眶底修复。术前有26.6%的患者出现早期复视，3.30%的患者出现眼球内陷。在早期复视的患者中，60%需要进行修复，而在无早期复视的患者中，36.6%接受了软骨移植。未观察到严重并发症。
眶底探查是治疗颧上颌复合骨折的一种辅助手段，可对病变进行精确诊断并正确判断修复指征。
