Yoshioka N, Tominaga Y, Motomura H, Muraoka M
Department of Plastic and Reconstructive Surgery, Osaka City University Medical School, Japan.
Ann Plast Surg. 1999 Jan;42(1):87-91. doi: 10.1097/00000637-199901000-00015.
The authors present 2 patients with greater sphenoid wing fractures that were treated surgically. This type of fracture is classified as a blow-in fracture of the lateral orbital wall. The first patient was a 16-year-old boy who was involved in a motor vehicle accident. Computed tomography (CT) disclosed a medial displacement of the inner wall of the greater sphenoid wing of the left orbit. He was unconscious for 3 days. After he recovered consciousness, he presented limited abduction of the left eye with diplopia in all gaze directions and mild left proptosis. Although these symptoms did not improve for 1 week, displaced bone fragments of the greater sphenoid wing were removed via the lateral orbital approach. The patient had a good postoperative course with progressive improvement in eye movement over the next several weeks. The second patient was a 22-year-old man whose face was hit in a fight. CT disclosed medial displacement of the inner wall of the greater sphenoid wing of the left orbit. Although the patient also presented limited abduction of the left eye on admission, this symptom improved gradually. However, diplopia in all gaze directions and mild left proptosis did not improve. Therefore, the displaced inner wall of the greater sphenoid wing was reduced via the lateral orbital approach. The patient showed a good postoperative course with progressive improvement over the next several weeks. This type of orbital fracture, which is classified as an orbital blow-in fracture, is relatively rare. This type of greater sphenoid wing fracture is caused by buckling of the orbital wall secondary to severe compression of the orbital rim. Surgical treatment using the lateral orbital approach through a hemicoronal skin incision afforded a wider operative field and better cosmetic result.
作者报告了2例接受手术治疗的蝶骨大翼骨折患者。这种骨折被归类为眶外侧壁的爆裂性骨折。首例患者为一名16岁男孩，遭遇机动车事故。计算机断层扫描（CT）显示左眼眶蝶骨大翼内壁向内侧移位。他昏迷了3天。苏醒后，他出现左眼外展受限，所有注视方向均有复视，以及轻度左眼球突出。尽管这些症状1周内未改善，但通过眶外侧入路切除了移位的蝶骨大翼骨碎片。术后患者恢复良好，在接下来的几周内眼球运动逐渐改善。第二例患者是一名22岁男性，在打架中面部受击。CT显示左眼眶蝶骨大翼内壁向内侧移位。尽管患者入院时也有左眼外展受限，但该症状逐渐改善。然而，所有注视方向的复视和轻度左眼球突出并未改善。因此，通过眶外侧入路对移位的蝶骨大翼内壁进行了复位。术后患者恢复良好，在接下来的几周内逐渐好转。这种被归类为眶爆裂性骨折的眼眶骨折相对少见。这种蝶骨大翼骨折是由于眶缘严重受压导致眶壁屈曲所致。通过半冠状皮肤切口采用眶外侧入路进行手术治疗，可提供更广阔的手术视野和更好的美容效果。
