眶缘眶壁分层截骨术治疗眼眶及眶周畸形

Surgical correction of orbital and periorbital deformities using lamella and complex osteotomies

目的 探讨眶缘眶壁分层截骨术治疗眼眶及眶周畸形所致的眼眶容积异常、眶缘错位、眼水平轴失衡、眼球凹陷及复视等的效果。方法 对眶距增宽症、双眼眶不对称、放疗后小眼眶、外伤后眼眶畸形等患者 ,取头皮冠状切口入路 ,按畸形发生的不同部位 ,选用眶缘部眶壁分层截骨、固定 ,或多个眶缘部眶壁复合分层截骨、固定。结果 4 4例患者中 ,眶上缘截骨 5例 ,眶内壁截骨 8例 ,眶下缘截骨 3例 ,眶外缘截骨 2例 ,眶外下缘复合截骨 2 6例 ,术后无并发症。手术前后测量结果显示 ,骨性眶间距、双侧眼球突出度、双眶连线与双耳屏连线的交角、双眼外眦与双耳屏连线距离等均较手术前有明显改善。结论 眼眶壁和眼眶缘的分层截骨术可以有效矫正不同类型的眼眶畸形。

Objective To investigate surgical correction of orbital and periorbital deformities in orbital and periorbital region. Methods In order to reconstruct orbital deformities such as orbital hypertelorism, orbital dystopia, radiated orbit, and secondary deformities of traumatic orbit, lamella osteotomies of either orbital rim and wall or complex osteotomies of both adjacent orbital rims and walls using bicoronal or galea aponeurotica incision were employed. The reconstructed complex was placed in new position with rigid fixation. Clinic evaluations were performed before and after operative osteotomies such as cephalometry (measurement of interorbital distance,IOD), exophthalmos (measurement with Hetel exophthalmometer), the angle (between orbital horizontal level and bilateral tragus linkage,A-OT), and the linear distance (between lateral canthus and tragus,LC-T), then the gap differences were analyzed before and after operation. Results Nearly normal orbital volumes, better contour of orbit and midface, improved eyelids and visions were achieved in total 44 cases. There were 5 cases of supraorbital osteotomy (intracranial routine), 8 cases of medial orbital osteotomy, 3 cases of inferior orbital osteotomy, and 28 cases of both lateral and inferior orbital osteotomy in these series. No complications were found after surgery. The orbital and midfacial appearances were improved significantly. Conclusions Lamella and complex osteotomies of orbital rim and wall are proved to be safe and effective to correct most deformities of orbital and periorbital region and various kinds of orbital malposition.