眼窩内側壁骨折に対して外来で行う内視鏡下整復

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  • Minimally Invasive Treatment with Endoscope for Traumatic Outpatients with Fracture of the Medial Wall of Orbit
  • ガンカウチガワヘキ コッセツ ニ タイシテ ガイライ デ オコナウ ナイシキョウ カ セイフク

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Objective; Minimally invasive treatment for medial wall fracture of orbit can be well performed for traumatic outpatient under local anesthesia, even in children. Prompt recovery of damaged orbital movement and less invasive surgery are important for this kind of trauma.<br>Case and Method; Three outpatients were treated within a few days after trauma. They are 12 year old boy, 24 and 50 year old men. They claimed strong orbital pain to look medially rather than double vision and needed apparently prompt repair.<br>Local anesthesia was insertion of several pieces of small cotton gauze embedded 4% xylocaine and 0.5% epinephrine. With 4 mm diameter endoscopic aided surgery, the fracture part in the nasal middle meatus could be seen clearly and repaired with surgical elevator. They might feel small pain during the surgery, but pain and bleeding were well controlled and operation time was less than twenty minutes including anesthesia. Immediately after repair, they could feel no orbital pain and no other associated problem.<br>Result and Conclusion; Traumatic fracture between orbit and paranasal sinus needs prompt and adequate treatment for orbital movement and cosmetic appearance. The fracture is classified into two lesion, blow-out fracture of inferior floor of orbit and superior wall of maxillary sinus (inferior type), fracture of medial wall of orbit and anterior ethmoidal cell (medial type). Symptoms and treatments differ in those two types. Treatments also varied in two types between Rhinology, Plastic surgery and Ophthalmology.<br>Our strategy in surgical treatment needed case is trans-maxillary-sinus approach for inferior type under general anesthesia, and endoscopic nasal approach with local anesthesia in outpatient clinic for medial type.<br>The endoscopic observation of fracture part and careful repair under sufficient local anesthesia are necessary for this treatment. The surgical results are very safe and satisfied outcome for patients and our medical stuff.

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