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經淚阜眶切開術－進入內側眼窩的新方法
Transcaruncular Orbitotomy - A new Approach to the Medial Wall
Abstracts
目的：本文將介紹經淚阜眶切開術（transcaruncular orbitotomy）的手術方式，以及我們處理甲狀腺眼疾併視經病變，內側眼窩腫瘤以及額篩竇黏液囊腫的經驗。病人與方法：自民國八十八年七月至民國九十年三月，於臺大醫院共有16例甲狀腺眼疾併視神經病變，3例內側眼窩腫瘤，以及3例額篩竇黏液囊腫，接受經淚阜眶切開術。結果：所有的病人在外觀及功能上均獲得改善。結論：傳統上，使用Lynch incision approach是進入內側眼窩的一種很好且直接的方法。但是，卻有不少無法避免的缺點。而經淚阜眶切開術則提供了進入內側窩比較安全、快速的新方法；而且皮膚沒有疤痕，所以比較美觀。對於內側眼窩的病變：如甲狀腺眼疾併視神經病變、內側眼窩腫瘤、額篩竇黏液囊腫、內側眼窩骨折、眼窩尖的病變、眼窩或骨膜下膿瘡等的處理，在臨床上都可以利用經淚阜眶切開術來處理。
Parallel abstracts
Objective: In this presentation, we will demonstrate the deatails of transcaruncular orbitotmy as well as our experience in the treatment of optic neuropathy in thyroid eye disease, medial orbital tumors, and frontoethomoidal mucoceles. Patients and Methods: Sixteen patients with optic neuropathy in thyroid eye disease, 3 with medial orbital tumors, and 3 with frontoethmoidal mucoceles received transcaruncular orbitotmy from July, 1999 to March, 2001 at National Taiwan University Hospital. Resuts: Both cosmetic outcome and functional recovery were excellent. The visual acuity improved in cases wit hoptic neuropathy in thyroid eye disease. Proptosis disappeared in cases with frontoethmoidal mucoceles. Conclusion: traditionally, a Lynch incision gives an excellent access to the medial orbital area, but it still has some disadvantages, such as obvious skin scars and easily adjacent tissue damage including medial canthal tendon, lacrimal sac, and superior oblique muscle tendon. Transcaruncular orbitotomy can provide a safer and more rapid access to the medial orbit. Furthermore, it provides a superior cosmetic result owing to reduced postoperative scarring. It is very useful for managing optic neuropathy in thyroid eye disease, medial orbital tumors, frontoethmoidal mucoceles, medial wall fractures, and orbital apex lesions, as well as orbital or subperiosteal abscess.