26 KB475 KB23 KB192920262002Dovšak, DavidKansky, Andrejletnik:71str. II-25-II-30številka:supl. 2ISSN:1318-0347COBISSID:14709721URN:URN:NBN:SI:doc-COVJYEVPslSlovensko zdravniško društvoZdravniški vestnikDiagnosisEye injuriesIzid zdravljenjakostiOčesne poškodbeoftalmologijaokoOrbital fracturesOrbitalni zlomipoškodbeSurgerytherapyTreatment outcomezdravljenjezlomiPoškodbe orbite| Orbital injuries|Background. Orbit is involved in 40% of all facial fractures. There is considerable variety in severity, ranging from simple nondisplaced to complex comminuted fractures. Complex comminuted fractures (up to 20%) are responsiblefor the majority of complications and unfavorable results. Orbital fractures are classified as internal orbital fractures, zygomatico-orbital fractures, naso-orbito-ethmoidal fractures and combined fractures. The ophtalmic sequelae of midfacial fractures are usually edema and ecchymosis of the soft tissues, subconjuctival hemorrhage, diplopia. iritis, retinal edema, ptosis, endophthalmos, ocular muscle paresis, mechanical restriction of ocularmovement and nasolacrimal disturbances. More severe injuries such as optic nerve trauma and retinal detachments have also been reported. Within thewide range of orbital fractures small group of complex fractures causes most of the sequelae. Therefore identification of severe injuries and adequatetreatment is of major importance. The introduction of craniofacial techniques made possible a wide exposure even of large orbital wall defects and their reconstruction by bone grafts. In spite of significant progress, repair of complex orbital wall defects remains a problem even for the experienced surgeons. Results. In 1999 121 facial injuries were treated at ourdepartment (Clinical Centre Ljubljana Dept. Maxillofacial and Oral Surgery). Orbit was involved in 65% of cases. Isolated inner orbital fracturespresented 4% of all fractures. 17 (14%) complex cases were treated, 5of them being NOE, 5 orbital (frame and inner walls), 3 zygomatico-orbital, 2FNO and 2 maxillo-orbital fractures. Conclusions. Final result of the surgical treatment depends on severity of maxillofacial trauma. Complex comminuted fractures are responsable for most of the unfavorable results and ocular function is often permanently damaged (up to 75%) in these fracturesIzhodišča. Pri obraznih poškodbah je orbita udeležena v približno 40%. Poškodbe so po teži zelo različne od enostavnih zlomov brez dislokacije do zapletenih kominutivnih poškodb. Delimo jih na notranje poškodbe orbite, orbitozigomatične, nazo-orbito-etmoidalne in kombinirane zlome. Slednjih je petina vseh poškodb orbite. Ti so odgovorni za večino zapletov pri zdravljenju. Znaki poškodb orbite so edem, ekhimoza, subkonjuktivalna krvavitev, diplopija, ptoza, enoftalmos, pareza očesnih mišic, mehanične ovireza gibanje očesa, poškodbe nazolakrimalnega kanala. Opisane so poškodbe optičnega živca in odstop mrežnice. Enostavni zlomi brez funkcionalnih izpadovne potrebujejo kirurškega zdravljenja, enostavne zigomatično-orbitalne zlome z manjšo dislokacijo zdravimo z repozicijo. Vse ostale zlome orbite zdravimo z repozicijo, rekonstrukcijo in osteosintezo. Pri obsežnih zlomih notranjih sten orbite moramo le-te rekonstruirati s prostimi kostnimi presadki. Kljub napredku stroke v zadnjem času ti zlomi še vedno predstavljajoresen kirurški problem. Rezultati. V letu 1999 smo na Kliniki za maksilofacialno in oralno kirurgijo operirali 121 obraznih poškodb. Pri 65% jebila ob ostalih poškodbah prizadeta tudi orbita. Samo orbita je bila prizadeta v 4%. Kombiniranih poškodb smo imeli 17 (14%), od tega je bilo pet NOE, pet orbitalnih (okvir in notranje stene), tri zgiomatično-orbitalne, dve fronto-nazo-orbitalni (FNO) in dve orbito-maksilarni. Zaključki. Uspešnost kirurškega zdravljenja je v prvi vrsti odvisna od obsežnosti poškodbe. Kompleksne poškodbe orbite imajo v visokem odstotku (do 75%) za posledico trajno poškodbo očesne funkcijeTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo