局部小切口在颧眶复合体骨折坚固内固定术中的临床应用

目的 探讨局部小切口在颧眶复合体骨折坚固内固定术中的方法和疗效评估。方法 28例颧眶复合体骨折患者,采用睑缘下切口、眼外眦外侧切口联合颞部发际线内切口切开复位,并坚固内固定。结果 所有患者创口Ⅰ期愈合,术后无并发症发生,且功能和外形恢复满意。结论 局部小切口在颧眶复合体骨折坚固内固定术中具有切口小而隐蔽、安全、复位效果好及患者满意的优点。     

经冠状切口联合下睑缘切口治疗复杂面中部骨折

目的：探讨经冠状切口联合下睑缘切口行复杂面中部骨折坚强固定术的临床应用价值。方法：本组28例患者采用头皮冠状切口联合下睑缘切口行面中部骨折解剖复位，Mini或Micro钛接骨板坚强内固定。结果：28例均一期愈合，面部畸形得到明显改善，咬合关系恢复正常，无面神经的损伤。结论：采用头皮冠状切口联合下睑缘切口的坚强内固定技术大大减少了传统的面中部复杂骨折治疗所带来的复位不准确、固定不可靠、术后遗留面部畸形等并发症，使面中部解剖结构得以重建，提高了骨折固定的稳定性，取得了良好的疗效。     

耳颞切口联合下睑缘切口治疗颧眶复合体骨折

目的:评价耳颞切口联合下睑缘切口入路可吸收接骨板坚强内固定治疗颧眶复合体骨折的疗效。方法:采用耳颞切口联合下睑缘切口,显露复位颧弓骨折段后应用可吸收接骨板对21例颧眶复合体骨折患者进行坚强内固定,应用面形、张口、伤口愈合情况评价手术效果。结果:21例患者均开口度正常,颧面部及眼部畸形明显改善,伤口甲级愈合,手术效果良好。结论:以耳颞切口联合下睑缘切口入路,可吸收接骨板行颧眶复合体骨折坚强内固定,操作简便,损伤小,并发症少,效果良好。     

下睑缘切口颧骨骨折复位内固定术的临床应用

作者于 1998年以来采取下睑缘切口对 10例移位性颧骨骨折患者进行了复位及小型接骨板固定术 ,报告如下一、材料与方法1.10例均系我院口腔颌面外科自 1998年 5月至 1999年 9月间收治的患者。年龄 17～ 40岁 ,平均 2 9.5岁 ,均为交通事故伤。受伤至手术时间为 7～ 14天 ,平均 9.2天。采用第四军医大学研制的小型接骨板 ,共 11种形态 ,螺钉长度为5ｍｍ～ 15ｍｍ ,直径 2ｍｍ2 .切口设计和手术操作 :除 3例全麻外其余 7例均采取局部麻醉。切口自下睑泪小点外侧睑缘下方 2ｍｍ处切开皮肤 ,由内向外至外眦角绕向上外沿皮纹向颞侧延伸 10ｍｍ～15ｍ…     

下睑缘外眦切口切开固定治疗颧骨复合体骨折

目的:探讨下睑缘外眦小切口配合口腔前庭沟切口治疗颧上颌骨复合体骨折的效果。方法:分析25例颧上颌骨复合体骨折患者采用面部小切口切开坚强内固定治疗的临床资料。结果:所有患者愈后面部无明显畸形,面中部突度恢复,无复视,无睑外翻、溢泪,张口度恢复正常。5例遗留面中部麻木。结论:采用下睑缘外眦小切口配合口腔前庭沟切口可以达到三维立体固定颧骨复合体的效果,手术创伤小,操作过程简单,效果可靠。     

颧骨骨折睑下切口复位内固定术18例报告

颧骨骨折在临床上比较常见,手术复位内固定的切口选择很多,从简单的局部小切口到复杂的半冠状切口;从口内切口到口外切口;从单一切口到多处联合切口,在治疗不同类型的颧骨骨折中各有利弊,难以取舍和规范。本文采用睑     

下睑结膜切口外眦切开入路在颧眶区骨折中的应用

由颧骨、上颌骨及额骨构成的颧眶区是面中份骨质较薄弱的区域之一 ,易受外伤而致骨折及骨质缺损。对其骨折的复位及缺损修复的最佳时机是创伤早期。早期开放复位 ,可探查眶内各壁情况 ,解除嵌顿的肌肉 ,达到理想的解剖复位及重建。作者应用下睑结膜切口及外眦切开入路治疗 49例颧眶区骨折患者 ,认为该切口入路能最大限度地暴露骨折断端及缺损部位 ,易于探查骨折情况及手术复位固定的操作 ,组织损伤较小 ,并发症少。1　临床资料和方法1.1　一般资料作者于 1994年 4月～ 1999年 10月对 49例颧眶区骨折患者应用下睑结膜切口及外眦切开入路进行…     

双重睑切口在颧额缝骨折内固定入路的临床应用

目的　探讨双重睑切口在颧额缝骨折内固定入路的临床应用效果。方法　选取12例颧骨复合体骨折、骨折段移位明显、伴有面部塌陷或张口受限等功能障碍患者,行局部小切口切开复位内固定术,其中颧额缝采用双重睑切口入路,术后评价骨折复位固定、功能和畸形改善、术后瘢痕等情况。结果　所有骨折复位固定方便,患者颧面部外形满意,功能改善明显,术后瘢痕隐蔽。结论　双重睑切口作为颧骨复合体骨折复位内固定其中的手术入路,既能达到骨折复位,又能减少创伤,具有一定的临床使用价值。     

经眶周小切口治疗颧骨复合体骨折

目的：介绍经眶周小切口复位同定颧骨复合体骨折（ZMC）的方法与疗效。方法：共治疗93例ZMC骨折，其中单纯经眶周（眉弓外侧和下睑缘下）小切口复位58例（62％），眶周小切口＋上颌前庭沟切口复位35例（38％）。术后行临床疗效和影像学观察，随访半年。结果：84例（90％）痊愈，面部畸形与眼球功能障碍完全恢复，眶周无明显瘢痕；9例（10％）明显改善。结论：ZMC骨折经眶周小切口入路治疗创伤小，疗效好，可同期进行眶底探查与眶底骨缺损重建，对复杂性骨折还需联合口内切口复位固定。     

眶下进路在颧骨复合体骨折中的应用

目的:寻求颧骨复合体骨折手术治疗减小面部遗留瘢痕的方法。方法:对51例患者采用改良式眶下进路治疗颧骨复合体骨折,对以往眶下缘切口从睑缘改为骨性眶下缘位置即在患者下睑缘下1cm处,相当于眼轮匝肌下方眼袋的位置作同眼轮匝肌方向一致的弧形切口,切开皮肤皮下组织,钝性分离,推眼轮匝肌向上后直达眶下缘,切开骨膜,暴露眶下缘骨折处,其它小切口未做改变。术后均随访2～3个月,对其疗效进行评价。结果:切口隐蔽性好,而且可以充分暴露眶下缘、眶外侧壁、颧弓以及颧牙槽嵴骨折端,所有患者术后均Ⅰ期愈合,患者术后颧骨左右对称性、咬合功能及局部感觉均获得满意效果,除1例由于是疤痕体质面部小切口疤痕比较明显外,其余病例面部疤痕均不明显。结论:该方法创伤小,显露好,路径短,顺皮纹方向,只留下线样切口愈合,疤痕小不影响面部的整体美观。     

颧眶骨折合并眼球内陷的治疗

目的：总结颧眶骨折合并眼球内陷的整复方法。方法：采用头皮冠状切口等入路,将骨折断端显露、复位、固定,回纳嵌顿的眶内软组织,颅骨外板或Medpor修复缺损。结果：7例患者经治疗,眼球内陷均得以矫正,颧部外形得以改善。结论：重建眼眶的特殊解剖结构是手术关键,术中还应对眼球内陷过矫正。     

改良耳颞-结膜-口内联合切口治疗眼眶-上颌-颧骨、颧弓复合体骨折

目的:探讨对眼眶-上颌-颧骨、颧弓复合体骨折采用改良耳颞-结膜-口内联合切口,行骨折切开复位内固定术。方法:170例患者分为两组:对照组(88例)采用常规冠状-睑下缘-口内联合切口,实验组(82例)采用改良耳颞-结膜-口内联合切口,均行骨折切开复位内固定术。比较两组患者的手术时间、术中出血量、切口长度、术后切口肿胀及瘢痕程度、术后局部积液、面神经及眶下神经功能、耳颞区感觉功能、泪道损伤发生率、下眼睑外翻及颞部凹陷的发生率、骨折复位的效果、患者满意度,综合评价治疗效果。结果:两组患者手术时间、术中出血量、切口平均长度、术后切口肿胀及瘢痕程度、术后局部积液、面神经功能障碍、耳颞区感觉障碍、泪道损伤发生率、下眼睑外翻及面颞部凹陷的发生率、患者满意度比较具有显著性差异(P<0.05)。两组患者眶下神经功能、骨折复位的效果比较无显著性差异。结论:改良耳颞-结膜-口内联合切口具有切口隐蔽,损伤小,并发症少等优点,值得在临床上进一步推广应用。     

Transantral endoscopic orbital floor repair using resorbable plate

The transantral endoscopic orbital floor approach can be used to repair pure orbital floor blowout fractures, avoiding the risks of lower lid incisions. A transoral incision is made to expose the anterior maxillary wall. A 1-cm2 antral bone flap gives access to the maxillary sinus and infraorbital floor. The size and fracture configuration are defined using a 30-degree, 4-mm endoscope. Stable bony shelves are identified adjacent to the fracture. Resorbable bone plating material is cut slightly larger than the defect. The material is introduced through defect, rotated, and allowed to rest on the stable medial, lateral, and anterior orbital shelves. Fixation is not required if there is adequate stability of the bony shelves. If not, direct screw fixation can be done from below.     

脱套入路在鼻眶筛区骨折治疗中的应用

目的:探讨面中部脱套入路治疗鼻眶筛区骨折的疗效。方法:选取佛山中医院口腔医疗中心鼻眶筛骨折患者11例,均为单侧一类骨折,其中眶区骨折6例,鼻区骨折5例。所有患者采用面中部脱套入路行骨折复位内固定术或隆鼻术。结果:11例患者术后随访3～12个月,伤口均一期愈合,所有患者均有鼻腔结痂和出血现象,创伤性溢泪1例,眶下区麻木4例,鼻部歪斜1例。结论:面中部脱套入路治疗鼻眶筛区骨折操作安全,术野暴露充分,面部不留瘢痕,无鼻前庭狭窄等并发症发生,值得临床推广应用。     

Treatment of zygomatic fractures without inferior orbital rim fixation

Zygomatic fractures can be associated with functional and esthetic problems. Recent improvements in surgical techniques and materials have enabled stable fixation of zygmomatic fractures. Multiple-point fixation is most commonly used for internal fixation. Generally, reduction and fixation are performed through lateral brow, subciliary, temporal, or intraoral incisions (three-point fixation). Our experience indicates that postoperative scarring and sensory disturbances are caused by a subciliary incision with inferior orbital rim fixation. It is thus recommended that inferior orbital rim fixation with mini- or microplates be avoided. In patients in whom the fracture does not involve the orbital floor, reduction of the zygoma and zygomatic arch through a temporal incision is performed at this institution. Fixation of the lateral zygomaticomaxillary buttress and anterior wall of the maxilla with miniplates through an intraoral incision is also performed. If necessary, zygomaticofrontal suture fixation with a miniplate or wire is performed through a lateral brow incision. The status of inferior orbital rim reduction is confirmed by palpitation. Inferior orbital rim fixation with mini- or microplates is recommended for reduction of comminuted fractures and orbital floor fractures with herniation of internal orbit components. Patients who did not undergo inferior orbital rim fixation were free of inferior orbital rim deformity, diplopia, and postreduction rotation.     

眶下径路治疗颧骨复合体骨折的临床评价

目的：对眶下径路治疗颧骨复合体骨折的临床疗效进行评价。方法：对65例颧骨得合体骨折作临床分析,经眶下径路作开放整复加微型钛板坚强固定手术。结果：（1）眶下径路术野暴露充分;（2）颧骨复合体骨折复位快,对位精确;（3）微型钛板固定坚固;（4）无面神经损伤等并发症;（5）疗效优良率达96．9％。结论：眶下径路适宜于颧骨复合体骨折的治疗。     

Comparison of various approaches for exposure of infraorbital rim fractures of zygoma

Objective  The aim of this study was to randomly compare four incisionssubciliary, subtarsal, infraorbital and transconjunctival with lateral canthotomy for treatment of orbital rim or floor fractures. Methods  40 patients with zygomatic complex fractures either isolated or in association with pan facial fractures, were selected for the study. They were divided into four groups of 10 patients each, Group I-Transconjunctival with lateral canthotomy, Group II-Subciliary [single eyelid incision], Group III-Subtarsal incision, and Group IV-Infraorbital incision. The following parameters were compared a) The average time from incision to fracture exposure b) The amount of exposure of the site provided c) The aesthetic appearance of the ‘scar’ d) Complications e) Factor of ‘time’ — its effect on scar and complications. Results  The study revealed that all four incisions provided adequate exposure of fracture site and transconjunctival (22 minutes) required the maximum time for exposure. The complications included ectropion in group I and prolonged edema in group IV. Group II and III patients had relatively lesser number of complications. Group IV patients had visible scar as compared to no scar in group I patients. Conclusion  We conclude by saying that transconjunctival approach provides an excellent aesthetic result when done meticulously. However the subciliary and the subtarsal incisions provide a more rapid, direct approach to the orbital floor and infraorbital rim with minimal morbidity and an aesthetically acceptable scar. The infraorbital incision is the least acceptable aesthetically.     

Orbital floor restoration with traction of the infraorbital nerve using a vessel loop in posterior orbital floor fractures

BackgroundThe authors retracted the infraorbital nerve (ION) using a vessel loop to explore the orbital floor fracture site and analysed when the traction of the ION was needed.MethodsIn ninety-one patients, the location of the fracture according to its position relative to the infraorbital groove, the location of the infraorbital groove from the midpoint of the orbital floor, and involvement of the ION in the fracture site were recorded retrospectively from computed tomography scans. An analysis of any associations between the traction of ION and the location of the fracture and ION passage was performed.ResultsTraction of the ION was performed in 14 cases, of which 10 cases had involvement of the ION in the fracture site and 4 cases did not. All of them were posterior fractures. In 51 cases with posterior fractures, the ION passage in patients who had ION traction was statistically located more medially (0.50 ± 1.19 mm) than in patients who had no traction (2.38 ± 1.12 mm) (p < 0.05).ConclusionThe ION may interfere with the exposure of the fracture site in a posterior orbital floor fracture with the involvement of the ION in the fracture site and a medially located ION passage.     

Use of the preseptal transconjunctival approach in orbit reconstruction surgery.

PURPOSE: This report evaluated the advantages of the preseptal transconjunctival approach in reconstruction of the orbit. PATIENTS AND METHODS: Ninety-nine preseptal incisions were used in 80 patients for different indications (blowout fracture, complex zygoma fracture, enophthalmos correction, midface hypoplasia, secondary incision). All operative procedures were performed without an additional lateral canthotomy. The infraorbital rim was stabilized with miniplates or microplates. RESULTS: There was no ectropion or entropion in any patients. Complications included 1 laceration of the tarsal plate and 1 temporary entropion after a primary subciliary incision. The overall complication rate was 2%. CONCLUSIONS: The preseptal transconjunctival incision without lateral canthotomy provides good exposure of the orbital floor and the caudal parts of the lateral and medial wall. This approach is preferable to a retroseptal approach in reconstructive orbital surgery because of minimal disturbance of the intraorbital connective tissue framework. The anatomic optimal dissection line also results in a lower complication rate.