外傷性鼻淚小管斷裂之初級修復

鼻淚小管位於眼瞼部分（特別是下眼瞼）若是因軟組織撕裂傷而斷裂卻不予以修補接合，易產生美觀上的問題且在功能上眼睛會有溢淚的情形發生。屬於眼瞼部分之鼻淚小管斷裂在臨床上的診斷並不困難，只要仔細觀察下眼瞼內側方是否有撕裂傷經過淚點內側方即可得知。聖馬爾定醫院口腔顎面外科自民國84年7月至99年6月處理過顏面軟組織撕裂傷的住院患者共920位，其中17位是因下眼瞼撕裂傷所造成的鼻淚小管斷裂而需要修補的患者，17位中有5位合併有中顏面部骨折。手術方式：在全身麻醉下，以3倍之Loupe找尋鼻淚小管斷裂之近、遠端，並以pig-tail probe及Dilator確定及擴大鼻淚管徑，再以帶探針之矽膠管穿過骨內部分之鼻淚管而至下鼻腔，由下鼻腔找出矽膠管與眼瞼端形成環繞，眼瞼部分的撕裂傷再以6-0 Novafil縫合，而矽膠管留置時間平均約8星期。結果：1.下眼瞼鼻淚小管斷裂在本院顏面軟組織撕裂傷之住院患者中發生率約1.8%。2.17位下眼臉鼻淚小管斷裂進行修復有15例成功，2例失敗。3.接合成功的患者皆無美觀及功能上的問題，失敗的患者皆需做第二次矯正手術。結論：下眼瞼之撕裂傷，口腔顎面外科醫師應注意有無鼻淚小管斷裂之情形，若有，經適當之修補接合，在美觀及功能上都能得到令人滿意的結果。

關鍵字

淚點；鼻淚小管；鼻淚管；溢淚

並列摘要

The rupture of the lacrimal canaliculus is often the result of trauma to the eyelids. A torn lacrimal canaliculus, especially the lower one, if not treated properly, can result in not only cosmetic problems to the eyelid, but also functional impairment of the lacrimal drainage system (Epiphora). Diagnosis is not difficult, careful examination of the wound found within the medial side of the lower punctum will clearly reveal the rupture. In the OMS department of St. Martin De Porres hospital, from July 1995 to June 2010, we treated 1102 facial trauma admissions. Of these, 17 patients had injuries to the eyelids combined with a rupture of the lower lacrimal canaliculus. Of these 17 patients, 5 also had midtacial bone fractures. Using Loupe magnification of 3, the distal and proximal parts of the tom lacrimal canaliculus were located under general anesthesia. A pig-tail probe was utilized in conjunction with a dilator. After dilation of the canaliculus, a special probe with a silicon tube was used to pass through the bony part of the nasolacrimal duct into the inferior nasal cavity, looping the tube once outside. The lower eyelid wound was sutured with 6-0 Novafil. The average tube indwelling was about 8 weeks. The final results showed that the incidence rate of lacrimal canaliculus injury for facial soft tissue trauma admissions was 1.8%. Out of 17 patients, 15 enjoyed successful repairs while 2 failures needed secondary correction. Post-surgery, none of the 15 successful repair patients suffered any functional impairment or cosmetic problems. In conclusion, trauma to the lower eyelid should alert the maxillofacial surgeon to a possible lacrimal canaliculus injury. Once diagnosed, only proper repair will deliver good cosmetic and functional results.

並列關鍵字

Lacrimal punctum ； Lacrimal canaliculus ； Nasolacrimal duct ； Epiphora

國際替代計量

外傷性鼻淚小管斷裂之初級修復

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