經上頜竇以內視鏡修補眼眶底吹破性骨折

Transmaxillary Endoscopic Repair of Orbital Floor Blowout Fracture

陳正文(Jeng-Wen Chen) ； 劉鳳明(Fang-Ming Liou) ； 王守仁(Shou-Jen Wang)

《台灣耳鼻喉頭頸外科雜誌》 41卷4期 (2006/08) Pp. 136-141

https://doi.org/10.6286/2006.41.4.136

摘要

眼眶底吹破性骨折係外力直接施壓於眼球或眼眶骨所造成，由於眼窩內容物陷落至上頜竇或篩竇內，若未及時治療，可能造成眼球內陷、複視甚至失明等後遺症。整形外科及眼科醫師常經結膜(transconjunctival)或眼瞼下(subciliary)切口進入眼眶底修補吹破性骨折，此方法雖能有效隱藏傷口，但仍有高達42%的病人術後出現眼瞼位置不正(eyelid malposition)等後遺症。本文報告一20歲女性，因車禍撞擊左側臉部造成眼眶底吹破性骨折，眼下直肌陷落嵌入上頜竇內，導致眼球內陷及複視。病人經保守療法無效後接受內視鏡經上頜竇修補，手術使用網狀鈦金屬板重建眼眶底，術後眼球內陷及複視情形消失，視力維持正常，左臉頰無麻痺狀況，追蹤至今已逾6個月無復發。特提出報告並回顧文獻，針對此類病人的手術適應症、手術時機與手術方法之選擇提出討論。

關鍵字

眼眶底吹破性骨折 ； 眼球內陷 ； 複視 ； 內視鏡經上頜竇修補 ； 網狀鈦金屬板

並列摘要

Orbital floor blowout fractures are caused by a traumatic force applied to the globe or surrounding bone. Orbital blowout fractures result in prolapse of the orbital contents into the maxillary or ethmoid sinuses. If untreated, these injuries can lead to enophthalmos, diplopia, and even permanent visual loss. Transconjunctival and subciliary approaches to orbital floor are commonly used by plastic surgeons and ophthalmologists. Although these incisions are invisible, they have known complications of postoperative eyelid malposition in up to 42% of patients. We reported a 20-year-old female presented as left orbital floor blowout fracture caused by a traffic accident. Left enophthalmos and diplopia were found due to entrapment of inferior rectus muscle. The symptoms showed no improvement during a week of observation. She underwent endoscopic transmaxillary repair of the orbital floor with titanium mesh. The patient was noted to have resolving enophthalmos and diplopia after surgery. The visual acuity remained unchanged and no symptom of facial parasthesia was noticed. Subsequently, the patient had an uneventful postoperative course. The literatures were reviewed, timing, indications of surgery, and various methods of reconstruction were discussed.

並列關鍵字

orbital floor blowout fracture ； enophthalmos ； diplopia ； endoscopic transmaxillary repair ； titanium mesh