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Fundamentals of Clinical Ophthalmology (part 9)

Việc đánh giá và điều trị các tổn thương hệ thống, khuôn mặt và sọ được ưu tiên hơn việc sửa chữa gãy xương quỹ đạo. Bệnh nhân gãy xương quỹ đạo cấp tính liên quan đến các xoang cạnh mũi nên được hướng dẫn không để thổi / mũi của mình trong 10 ngày và, theo quan điểm của tính chất tham đe dọa | PLASTIC and ORBITAL SURGERY a Figure 14.2 Gross restriction of up a and down b gaze after a hairline blowout fracture of the orbital floor with entrapment of fascia around inferior retus muscle. Figure 14.2 may recover better with the release of entrapped tissues within a day or two of injury. Management The assessment and treatment of systemic facial and cranial injury takes precedence over the repair of orbital fractures. The patient with acute orbital fracture involving the paranasal sinuses should be instructed not to blow his her nose for 10 days and in view of the sight-threatening nature of acute orbital cellulitis a short course of systemic antibiotics should be considered. Oral anti-inflammatory medications may be given after injury to accelerate the resolution of orbital inflammation and oedema. Orbital floor repair If surgical repair is indicated then the orbital floor is readily approached through a lower eyelid swinging flap Chapter 11 or a subciliary skin-muscle blepharoplasty flap Chapter 8 . Using one of these routes the orbital rim is exposed and the periosteum incised about 5mm outside the rim to leave a margin of periosteum for adequate closure in front of any orbital floor implant. The periosteum is raised into the orbit across the orbital floor until the site of fracture is located and then the periosteum around the sides of the fracture site is raised to define the extent of tissue incarceration particular care must be taken laterally as this area is liable to major haemorrhage from the infraorbital neurovascular bundle in the area of the inferior orbital fissure. There should be a clinically evident improvement in the forced duction test after the incarcerated orbital tissues are released completely from the fracture site and the whole of the fracture edge should be visible typically there is a ledge of normal orbital floor at the posterior edge of the fracture site. Although often not possible the sinus mucosa should be kept intact to avoid