经鼻爆裂性眶骨折眼球内陷的晚期整复

目的研究眼眶爆裂性骨折眼球内陷晚期手术整复的方法及疗效。方法回顾性总结1998～2002年不同人路手术治疗19例眼眶爆裂性骨折患者的手术疗效。结果17例患者的眼球内陷得到不同程度的矫正,2例治疗无效。术后复视症状完全消失4例,部分消失5例,无变化6例。结论眼眶爆裂性骨折眼球内陷的晚期重建复位手术获得满意疗效。     

鼻内镜下治疗广泛眶内壁骨折21例

2002年9月~2004年9月我科在鼻内镜下治疗广泛眶内壁骨折引起的眼球内陷、眼肌嵌顿者21例,取得了较满意的效果,现报告如下。1资料与方法1.1一般资料本组21例,男18例,女3例;年龄18~46岁。均为眼钝伤,术前查伤侧裸眼视力为0.3~1.2。眶CT显示:单侧广泛的眶内壁骨折,致眼球内陷,内直     

鼻内镜下眶内壁骨折整复手术的疗效分析

外伤性爆裂性眼眶骨折主要指发生于眶壁薄弱的内、下壁骨折,也称为击出性骨折。近年来发病率有增高趋势。我院2000年2月～2002年3月对单纯发生于眶内壁的爆裂性骨折伴眼球内陷及复视的21例病人,实施了鼻内镜下经筛窦行眶内壁骨折整复手术治疗,取得了满意疗效,现报道如下。1资料     

鼻内镜下骨移植修复术治疗眶内壁击出性骨折缺损3例

近期我院收治 3例眶内壁骨折缺损患者 ,行骨移植修复术 ,效果满意 ,报告如下。1 　 病例报告例 1　男 ,35岁。因车祸右腿胫腓骨骨折 2h收入我院骨科。入院 3d因右眼球活动受限、复视请我科会诊。行鼻眼冠状位CT检查 ,报告为上颌窦前壁、眶下壁骨折 ,眶内壁击出性骨折 ,右侧颧弓骨折。于伤后 7d在鼻内镜下检查鼻腔 ,可见鼻中隔近鼻腔底处骨折 ,成角畸形 ,角顶端偏向左侧 ,黏膜撕裂。先行鼻中隔矫正术 ,切取鼻中隔软骨留下备用 ;鼻中隔矫正整复术后 ,再于鼻内镜下切除右侧钩突、开放同侧筛房、清理淤血及碎骨片 ,发现眶内壁缺损 1cm× 1cm ,…     

鼻眶筛复合骨折的鼻整复手术

目的探讨鼻眶筛复合骨折的鼻整复的手术方法。方法回顾性总结2008年1月～2011年4月40例鼻眶筛复合骨折的病例资料,其中25例在外伤后2周内手术,15例在2周至2个月内手术,所有患者均采用钛板内固定技术对移位的骨组织进行复位固定。结果 40例患者均愈合。鼻面部外观匀称,鼻通气功能正常。结论鼻眶筛复合骨折需要尽快手术。对闭合复位手术效果不佳、创口污染较轻,且周围无化脓性病灶,清创后行钛板的内固定手术对形态和功能重建非常重要。     

内镜鼻窦手术中眶内壁陈旧性骨折的处理

目的了解接受内镜鼻窦手术(endoscopy sinus surgery,ESS)的慢性鼻及鼻窦炎伴或不伴鼻息肉(chronic rhinosinusitis with or without nasal polyps,CRSwNP/CRSsNP)患者眶内壁陈旧性骨折的出现情况和存在特点,并讨论ESS过程中眶内壁陈旧性骨折的处理原则。方法回顾分析2006年11月～2010年01月因CRSwNP/CRSsNP接受ESS的一组连续病例中眶内壁陈旧性骨折的出现情况、术前计划和术中所见、术后填塞情况以及术后眶部并发症出现情况等。结果 520例患者中,眶内壁陈旧性骨折出现率2.5%(1 3/520)。鼻窦病变累及范围、眶内容突入情况、额窦引流是否受影响都是决定是否开放受累气房的决定因素。术后近期和远期没有出现眶部并发症。结论眶内壁陈旧性骨折在因CRSwNP/CRSsNP接受ESS的患者中出现并不罕见;作为一个影响ESS疗效的因素,术前应充分评估其对眶内结构、功能和鼻窦引流、特别是额窦引流影响;只要计划充分,在顺利完成手术的前提下,眶内容的损伤程度可以降至最低。     

鼻额筛眶复合体骨折26例诊治体会

报告鼻额筛眶复合体骨折２６例，就其临床特征、诊断要点及治疗时机等进行讨论。     

Squamous cell carcinoma at sites of old maxillary fractures

Malignancies have been reported to occasionally arise in scar tissue following injury. One hypothesis involves prolonged overactivation of tissue repair systems due to chronic inflammation and irritation, although the pathogenesis of cancers occurring in scars is not fully understood. We describe here two cases with a history of maxillary fracture at the site where squamous cell carcinoma (SCC) subsequently developed. The first patient developed SCC 7 years after right maxillary fractures resulting from a traffic accident. He underwent chemoradiotherapy (70 Gy in 35 fractions) and maintained complete response (CR) for 10 months. The second patient developed SCC 3 years after sustaining right maxillary fractures in an ice hockey game. Radiotherapy and total maxillectomy were performed, but local recurrence arose and he has since been receiving chemotherapy.     

Blow-out fractures

Twenty-one cases of blow-out fractures were treated at Osaka University Hospital between June 1979 and February 1982. 52% of the patients were teenagers. The most important cause of a blow-out fracture was a fist-fight (48%). Most of the patients had diplopia caused by the disturbance of the eyeball movement, mainly in the upward or downward rotations. 19 of 21 patients were surgically treated. The prognosis was much more related to the severity of the fracture than the period between the injury and the surgical treatment.     

Management of nasal fractures

Fracture of the nasal skeleton is a relatively common injury. Satisfactory treatment requires appropriate skills, diagnosis, and management. Some injuries require immediate attention; others are better treated in delayed fashion. Closed reduction provides satisfactory treatment in the majority of nasal fractures; however, open reduction often is a more appropriate choice. Injuries to the nasal septum should be recognized and given proper treatment.     

Management of nasal fractures

Careful diagnosis and surgical management are the cornerstones of successful treatment of nasal fractures. The nose must be examined thoroughly after all swelling has resolved. Appropriate therapy is best carried out in a surgical suite under optimal conditions and anesthesia. A graded, step-wise plan, beginning with the simplest techniques and proceeding to the more complex, should be used. Postoperative follow-up should continue for at least 6 to 12 months to insure that proper healing and satisfactory results have been achieved.