Using a Titanium Mesh Plate to Reconstruct the Orbital Floor after an Incompletely Reduced Zygomaticomaxillary Complex Fracture

本文是報告利用鈦金屬網板矯正一位因車禍導致眼球嚴重內陷之病例。一位三十歲男性因車禍造成左顴上顎複合體骨折，合併眼窩底、鼻側壁和顳側壁及眶頂骨之嚴重外破性骨折，以及左眼球破裂。急診處置包括：剜除破裂的眼球並植入矽質眼中內置球，骨折復位固定並以矽片修補眶底。但是由於朝外後下方移位的顴上顎骨複合體沒有完全復位，眼窩之鼻側壁、顳側壁及眼窩頂也有沒有復位，加上墊在眼窩底的矽片也因質軟無法支撐眼窩組織的重量而下沈。因此病人在眼窩容量大增和眼球體積縮小情況下，左眼球內陷極為嚴重。病人於受傷後五個月來求診，希望能善其外觀，但是病人卻不願意再次接受顴上顎骨複合體的重新復位手術。顴上顎骨複合體不復位，不管用什麼方法或什麼材料來修補上下左右階有外破性骨折的眼窩壁或窩底，都無法明顯改善內陷的眼球。因此本病例採用硬度較高但仍具可塑素的鈦金屬網板，來重建眼窩底。方法是裁剪鈦金屬網2.5*4公分，折成L型。短的一邊用鈦金屬螺絲拴在下眶緣以固持整個鈦金屬網板，長的一邊即來做眼窩底，其位置較病人原有的眼窩底為高，而且整個網板朝後上逐漸高起，以便將整個眼球朝上朝前推出。術後病人的上眼臉雖然仍稍有凹陷現象，但眼球內陷的情形已有極顯著的改善，病人也很滿意。術後至今追蹤18個月，並無任何明顯後遺症。

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並列摘要

A 30 year-old male came to us for correcting his severe left enophthalmos five months after a facial trauma in a traffic accident. CT scan of his left orbit showed a greatly increased orbital volume, which was resulted rom the incomplete reduction of left zygomaticomaxillary complex (ZMC) fracture, unrepaired medial and lateral walls, and improper restoration of the orbital floor with a silicone sheet. Also, the decreased ocular volume, due to the evisceration of the ruptured eyeball with intraocular silicone ball implantation, contributed to the patient’s enophthalmos. Because the patient refused any kind of osteotomy for his incompletely reduced and malunion ZMC fracture in the procedures of orbital reconstruction, correction of his severe enophthalmos became very difficult if not impossible. Therefore, we used a piece of titanium mesh plate about 2.5-4 cm in size, and folded it into an L shape. The shorter part of the L-shaped plate was used to fix the whole plate by screwing it into the anterior surface of the inferior orbital rim. The longer part of the plate was used as a new orbital floor. To hold and push the intraocular implant upward and anteriorly, the longer part of the plate was adjusted to a level higher than the original floor, and was bent upward gently in the posterior part. Postoperatively, the severe enophthalmos was markedly improved, and the patient was satisfied although an evident supratarsal sulcus was still presents. After a follow-up of 18 months, no complication of migration, infection, or extrusion of the titanium mesh plate occurred.

並列關鍵字

zygomaticomaxillary complex fracture ； orbital floor feconstruction ； titanium mesh plate

國際替代計量

Using a Titanium Mesh Plate to Reconstruct the Orbital Floor after an Incompletely Reduced Zygomaticomaxillary Complex Fracture

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