|
NR. 4/2009
|
|
|
|
|
|
|
|
|
Leczenie operacyjne
zaburzeń ruchomości mięśni gałkoruchowych po urazach
rozprężających oczodołu
Surgical Management of the Extraocular Muscles Motility
Disturbances Following Blow-out Fracture of the Orbit
Piotr Loba1, Anna Grądziak3, Anna
Broniarczyk-Loba2
1 Klinika Chorób Oczu I Katedry Chorób Oczu
Uniwersytetu Medycznego w Łodzi
Kierownik: prof. dr hab. n. med. Wojciech Omulecki
2 Zakład Patofizjologii Widzenia Obuocznego i
Leczenia Zeza I Katedry Chorób Oczu Uniwersytetu Medycznego w
Łodzi
Kierownik: dr hab. n. med. Anna Broniarczyk-Loba
3 Studenckie Koło Naukowe przy Klinice Chorób Oczu I
Katedry Chorób Oczu Uniwersytetu Medycznego w Łodzi
Kierownik: prof. dr hab. n. med. Wojciech Omulecki |
|
|
|
|
|
|
|
| Summary: |
Recent considerable
increase in numbers of cranial and facial skeleton
injures, causes that their initial differential
diagnosis and treatment becomes of significant practical
importance. Ophthalmic complications can lead to
permanent handicap that will exclude patients from
professional or even social life.
Most common squeal of orbital trauma is a fracture of
inferior and medial wall (blowout fracture) and
subsequent extraocular muscles motility disturbances,
which can result in secondary strabismus and diplopia.
It may occur due to peripheral cranial nerve palsy,
incarceration of the extraocular muscle, or other
orbital soft tissue within the fracture, edema or
hemorrhage, or combination of the above.
Even when orbital floor fractures undergo successful
surgical repair, diplopia may fail to resolve, or new
diplopia may occur. Subsequently additional surgery on
extraocular muscles, in order to restore muscle balance,
may be required.
A multiplicity of factors must be taken into
consideration when planning strabismus surgery in such
patients. Preoperatively all patients should undergo
accurate measurements of strabismus angles in nine
positions of gaze. Plotting the Hess chart helps
determine which muscle or muscles are involved.
The most common muscle injured is the inferior rectus
and the medial rectus. Both weakness and/ or restriction
of these may occur.
Different surgical procedures for strabismus after
orbital fracture are reviewed in this paper. An
individually tailored plan of surgical management is
helpful to maximize the field of binocular single vision
following blow-out fracture. |
| Key words: |
trauma, blow-out fracture
of the orbit, secondary strabismus, surgical treatment. |
| Słowa kluczowe: |
uraz, złamanie
rozprężające oczodołu, zez wtórny, leczenie operacyjne. |
|
|
|
|
|
|
|
|
