Author/Editor		Vesnaver, Aleš
Title		Transkonjunktivni pristop pri rekonstrukciji zloma medialne stene orbite - prikaz primera
Translated title		Transconjunctival approach in reconstruction of medial orbital wall fractures - a case report
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 9
Publication year		2004
Volume		str. 243-7
Language		slo
Abstract		Background. Isolated medial orbital wall fractures are rare, albeit untoward injuries. They can cause development of horizontal diplopia, enophthalmos and retraction of the globe upon abduction. Condusions. In correction of medial orbital wall fractures, one has to reduce the herniated orbital fat and cover the bony defect with a transplant - either an osseous autotransplant or au alternative allotransplant. The medial canthus, i.e. medial palpebral ligament, which should not be desinserted, makes the surgical approach to the medial orhital wall more complicated. The classical approach is by a bicoronal incision which can cause substantial blood loss. Exposure of the inferior part of the fracture often requires an additional inferior palpebral subcilliary approach. The transconjunctival approach through the medial palpebral augle achieves thorough exposure of the entire fracture, the incision is small and blood loss negligible. The medial canthus represents no obstacle with this approach, as we stay dorsal to it throughout the procedure. Moreover, there are no skin incisions orscars with this procedure. The first patient, successfully operated at our institution, is presented in this article.
Summary		Izhodišča. Izolirani zlom leve orbite je redka, a neugodna poškodba. Kot posledica se lahko razvijejo horizontalne dvojne slike, enoftalmus in retrakcija bulbusa pri poskusu abdukcije. Zaključki. Pri korekciji zloma medialne stene orbite je treba reponirati orbitalno maščevje iz kostnega defekta in to mesto nato prekriti s transplantatom - bodisi kostnim avtotransplantatom, bodisi kakim od alotransplantatov. Zaradi medialnega kantusa oz. medialnega palpebralnega ligamenta, ki ga ne smemo dezinserirati, je kirurški pristop do medialne stene orbite težavnejši, kot bi bil sicer. Klasični pristop v tem primeru je sorazmerno obsežen bikoronarni pristop, pri katerem je izguba krvi lahko dokaj velika. Zaradi slabše preglednosti kavdalnega dela frakture je potrebno ta pristop pogosto kombinirati s subciliarnim pristopom skozi spodnjo veko. S transkonjunktivnim pristopom skozi medialni očesni kot pa dosežemo dobro preglednost celotne frakture, incizija je majhna in izguba krvi zanemarljiva. Pri tem pristopu nas medialni kantus ne ovira, saj ves poseg opravimo dorzalno od njega. Poleg tega na koži ni rezov in brazgotin. Opisujemo prvi primer, uspešno operiran na naši ustanovi.
Descriptors		ORBITAL FRACTURES FRACTURE FIXATION, INTERNAL ENOPHTHALMOS CONJUNCTIVA ADULT TOMOGRAPHY, X-RAY COMPUTED