Saunders C J, Whetzel T P, Stokes R B, Wong G B, Stevenson T R
Division of Plastic and Reconstructive Surgery, University of California Medical Center, Davis, USA.
Plast Reconstr Surg. 1997 Sep;100(3):575-81. doi: 10.1097/00006534-199709000-00003.
A cadaver and clinical study was performed to determine the value of transantral endoscopy in diagnosis and treatment of orbital floor fractures. Six fresh cadaver heads were dissected using a 30 degree, 4-mm endoscope through a 1 cm2 antrotomy. In the cadaver, the orbital floor and the course of the infraorbital nerve were easily identified. The infraorbital nerve serves as a reference point for evaluation of fracture size; three zones of the floor are described that are oriented relative to the infraorbital nerve. In the clinical study, nine patients with orbital floor fracture initially underwent endoscopy at the time of fracture repair: three patients had comminuted zygomatico-orbital fractures, five had monofragmented tetrapod fractures, and one had an isolated orbital blowout fracture. Endoscopic dissection of the orbital fractures revealed seven fractures with an area > 2 cm2 and two fractures with an area of < 2 cm2. The isolated orbital floor blowout fracture had entrapped periorbital tissue, which was completely reduced endoscopically. A separate patient with a < 2 cm2 displaced fracture also had stable endoscopic reduction. In the remaining seven patients, the endoscopic technique assisted with the floor reconstruction by identifying the precise fracture configuration as well as identifying the stable posterior ledge of the orbital floor fracture. There have been no complications in any of our patients to date. We conclude: (1) Transantral orbital floor exploration allows precise determination of orbital floor fracture size, location, and the presence of entrapped periorbita. The information obtained through endoscopic techniques may be used to select patients who would not benefit from lid approaches to the orbital floor and may possibly eliminate nontherapeutic exploration. (2) Transantral endoscopic orbital floor exploration assists the reduction of complex orbital floor fractures and allows precise identification of the posterior shelf for implant placement. (3) Transantral endoscopic techniques can completely reduce entrapped periorbital tissue caught in a trapdoor type of fracture.
进行了一项尸体和临床研究，以确定经鼻窦内窥镜检查在眶底骨折诊断和治疗中的价值。使用30度4毫米的内窥镜通过1平方厘米的上颌窦切开术对六个新鲜尸体头部进行解剖。在尸体中，很容易识别眶底和眶下神经的走行。眶下神经作为评估骨折大小的参考点；描述了眶底相对于眶下神经的三个区域。在临床研究中，九名眶底骨折患者在骨折修复时最初接受了内窥镜检查：三名患者有粉碎性颧骨眶骨折，五名有单碎片四边形骨折，一名有孤立性眶爆裂骨折。对眶骨折进行内窥镜解剖发现，七处骨折面积>2平方厘米，两处骨折面积<2平方厘米。孤立性眶底爆裂骨折伴有眶周组织嵌顿，在内窥镜下完全复位。另一名骨折面积<2平方厘米且有移位的患者也在内窥镜下实现了稳定复位。在其余七名患者中，内窥镜技术通过确定精确的骨折形态以及识别眶底骨折稳定的后缘来辅助眶底重建。迄今为止，我们的患者均未出现并发症。我们得出以下结论：（1）经鼻窦眶底探查可精确确定眶底骨折的大小、位置以及眶周组织嵌顿情况。通过内窥镜技术获得的信息可用于选择那些无法从睑部入路处理眶底中获益的患者，并可能避免进行非治疗性探查。（2）经鼻窦内窥镜眶底探查有助于复杂眶底骨折的复位，并能精确识别用于植入物放置的后缘。（3）经鼻窦内窥镜技术可完全复位陷入活板门型骨折中的眶周组织。
