Endoscopic Transantral Repair of Bilateral Orbital Floor Fractures-A Case Report

經上頜竇內視鏡修補雙側眼眶底骨折－病例報告

郭宇正(Yu-Chen Kuo) ； 顏毓秀(Yu-Hsiu Yen) ； 吳瑞星(Simon Jui-Hsing Wu) ； 蒲啟明(Chi-Ming Pu)

《臺灣整形外科醫學會雜誌》 20卷2期 (2011/06) Pp. 148-154

https://doi.org/10.7096/TJTSPS.201106.0148

摘要

背景：
同時發生雙側單純眼眶底骨折是非常少見的，可能與病人佩戴半罩式安全帽有關。以往的修補手術多是經由結膜或下眼瞼的方式，無法完全將陷入上頜竇內之眼眶內容物復位，且易造成眼瞼的併發症，近年內視鏡手術盛行，可以徹底解決這些併發症的發生。
目的及目標：
藉由經上頜骨內視鏡修補手術，有別於以往手術方法，可以達成相同復位及眼底重建的功效，希望能避免造成下眼瞼的內外翻，以及肥厚性疤痕的產生，並將較深部之眼眶底骨折復位。
材料及方法：
我們報告一位三十歲年輕女性，因車禍造成雙側單純眼眶底骨折，受傷後十天左右，接受經上頜骨內視鏡修補手術合併矽膠片放置作眼眶底重建，因其左邊缺損及眼眶內壓力較大，不易單純由內視鏡復位，故合併開放式復位手術。
結果：
術後病人回復美觀，無相關併發症的發生，複視狀況改善，於術後兩個月電腦斷層追蹤沒有復發的跡象。
結論：
在上頜竇內操作內視鏡手術，因其空間狹小，在加上軟組織的沾黏有其困難度，主刀者需要一定的學習曲線；若以病患臉部美觀上考量，以及減少下眼瞼併發症，是一個值得嘗試的手術方法，尤其是對於困難復位的案例。

並列摘要

Background:
Bilateral pure orbital floor fracture is rare and maybe caused by the patient wearing half helmet during a road traffic accident. Orbital floor repair includes the release of the orbital contents and restoring the bony structure via a transconjunctival, subciliary or subtarsal incisions，which cause lower eyelid complications, and poor orbital contents reduction. Recently, endoscopic repair became popular. We try to reduce the orbital floor fracture with endoscopic assisted methods.
Aim and Objectives:
We describe a case of endoscopic transantral repair comparing with an open method, and achieving the goal of reduction and orbital floor reconstruction, while avoiding complications, such as ectropion, entropion or hypertrophic scarring.
Materials and Methods:
We present a 30-year-old patient with bilateral pure orbital floor fractures following a road traffic accident. Ten days later, the patient received endoscopic transantral repair with silastic sheet implantation for orbital floor reconstruction. Due to a large floor defect and raised intraorbital pressure of left side, the endoscopic procedure was combined with a subtarsal incision.
Results:
The patient achieves good aesthetic results without any lower eyelid complications often seen with open approaches. Her symptom of diplopia improved post-operatively. The computed tomography scan two months later after surgery showed good maintenance of bilateral orbital floor contours.
Conclusion:
Because of the limited space within the maxillary sinus and soft tissue tethering, it is often difficult to perform an endoscopic repair and the surgeon needs more time to overcome the learning curve. Due to aesthetic concern of the face, and avoidance of the lower eyelid complications, endoscopic repair is a viable alternative in orbital floor repair.

並列關鍵字

orbital floor fracture ； endoscopic repair