Öz
Aim: Traumas, infections, tumor invasions, and/or iatrogenic extensive bone resections are well-known causes of orbital wall defects. In addition to addressing aesthetic issues in the reconstruction of orbital wall defects, resolving clinically significant functional ophthalmic problems such as enophthalmos or dystopia is important.
Materials and Methods: This study was conducted on 4 female and 4 male cadavers, totaling 16 orbits, obtained from the BAU, Rhoton’s Anatomy Laboratory (Istanbul, Turkey). Mayfield head holders were used for positioning. Titanium mini-plate and mini-screw systems were used for replacing orbital wall defects and securing zygomatic arch (ZA) autografts in place.
Results: Optimal positioning principles were defined for visualizing anatomical landmarks. The cranio-orbito-zygomatic approach incision by Al-Mefty was modified with Gillie for dissection of the ZA. The ZA autograft secured with mini-plate/screw systems was successfully and compatibly replaced.
Conclusion: Modifications of different incision techniques can lead to better visualization. Detailed anatomical descriptions of selected anatomical regions and neighborhoods are important to prevent complications. ZA transposition, along with other known advantages of autografts, can be applied as an economical technique and can also be very useful in emergency situations.
Anahtar Kelimeler
orbital reconstruction zygomatic arc surgical technique neurosurgery anatomy
Kaynakça
- Cohen LM, Habib LA, Yoon MK. Post-traumatic enophthalmos secondary to orbital fat atrophy: a volumetric analysis. Orbit. 2020 Sep 2;39(5):319–24.
- Choi A, Sisson A, Olson K, Sivam S. Predictors of Delayed Enophthalmos After Orbital Fractures: A Systematic Review. Facial Plast Surg Aesthetic Med. 2022 Oct 1;24(5):397–403.
- Rajkumar GC, Ashwin DP, Singh R, Prashanth R, Rudresh KB. Ocular Injuries Associated with Midface Fractures: A 5 Year Survey. J Maxillofac Oral Surg. 2015 Dec 27;14(4):925–9.
- Stanley RB, Sires BS, Funk GF, Nerad JA. Management of Displaced Lateral Orbital Wall Fractures Associated with Visual and Ocular Motility Disturbances. Plast Reconstr Surg. 1998 Sep;102(4):972–9.
- Manolidis S, Weeks BH, Kirby M, Scarlett M, Hollier L. Classification and Surgical Management of Orbital Fractures: Experience With 111 Orbital Reconstructions. J Craniofac Surg. 2002 Nov;13(6):726–37.
- McNichols CH, Hatef DA, Thornton JF, Cole PD, de Mitchell CAG, Hollier LH. A Paradigm Shift in Correcting Medial Orbital Fracture–Related Enophthalmos. J Craniofac Surg. 2012 May;23(3):762–6.
- Nilsson J, Nysjö J, Carlsson AP, Thor A. Comparison analysis of orbital shape and volume in unilateral fractured orbits. J Cranio-Maxillofacial Surg. 2018 Mar;46(3):381–7.
- Bontzos G, Papadaki E, Mazonakis M, Maris GT, Kapsala Z, Blazaki S, et al. Quantification of effective orbital volume and its association with axial length of the eye. A 3D-MRI study. Rom J Ophthalmol. 2019;63(4):360–6.
- Tadj A, Kimble FW. The Gillies Method for fractured zygomas. ANZ J Surg. 2003;73(1–2):49–54.
- Al-Mefty O. Supraorbital-Pterional Approach to Skull Base Lesions. Neurosurgery. 1987;21(4).
- Muñoz R, Gajos G, Bladimir J, Carvajal D, Luis A, Del Valle Speranza G. Protocol for mandibular reconstruction with zygomatic implants (zygomatic mandibular implant). Oral Maxillofac Surg. 2018 Mar 28;22(1):39–44.
- Czerwinski M, Ma S, Williams HB. Zygomatic Arch Deformation: An Anatomic and Clinical Study. J Oral Maxillofac Surg. 2008 Nov;66(11):2322–9.
- Thijs D, Menovsky T. The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application. World Neurosurg. 2021 Jul;151:102–9.
- Swanson E, Vercler C, Yaremchuk MJ, Gordon CR. Modified gillies approach for zygomatic arch fracture reduction in the setting of bicoronal exposure. J Craniofac Surg. 2012;23(3):859–62.
- af Geijerstam B, Hultman G, Bergström J, Stjärne P. Zygomatic Fractures Managed by Closed Reduction: An Analysis With Postoperative Computed Tomography Follow-Up Evaluating the Degree of Reduction and Remaining Dislocation. J Oral Maxillofac Surg. 2008 Nov;66(11):2302–7.
- Yamamoto K, Murakami K, Sugiura T, Fujimoto M, Inoue M, Kawakami M, et al. Clinical Analysis of Isolated Zygomatic Arch Fractures. J Oral Maxillofac Surg. 2007 Mar;65(3):457–61.
- Li S, Xiao C, Duan L, Fang C, Huang Y, Wang L. CT image-based computer-aided system for orbital prosthesis rehabilitation. Med Biol Eng Comput. 2015 Oct 23;53(10):943–50.
- Huang YH, Seelaus R, Zhao L, Patel PK, Cohen M. Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report. Int Med Case Rep J. 2016 Nov;Volume 9:341–5.
- Laure B, Louisy A, Joly A, Travers N, Listrat A, Pare A. Virtual 3D planning of osteotomies for craniosynostoses and complex craniofacial malformations. Neurochirurgie. 2019 Nov;65(5):269–78.
- Day KM, Gabrick KS, Sargent LA. Applications of Computer Technology in Complex Craniofacial Reconstruction. Plast Reconstr Surg - Glob Open. 2018 Mar;6(3):e1655.
- Anabtawi M, Thomas M, Lee NJ. The Use of Interlocking Polyetheretherketone (PEEK) Patient-Specific Facial Implants in the Treatment of Facial Deformities. A Retrospective Review of Ten Patients. J Oral Maxillofac Surg. 2021 May;79(5):1145.e1-1145.e9.
- Adam AADM, Zhi L, Bing LZ, Zhong Xing WU. Evaluation of Treatment of Zygomatic Bone and Zygomatic Arch Fractures: A Retrospective Study of 10 Years. J Maxillofac Oral Surg. 2012 Jun 28;11(2):171–6.
- Tianzhi Z, Yingwu S, Zijian Y, Yingxi W, Yafei X, Yunze Z, et al. A Modified Technique to Harvest Integrated Zygomatic Arch-Temporal Bone Flap: Clinical Experience. Neurol India. 2022;70(1):325–30.
Öz
Amaç: Travmalar, enfeksiyonlar, tümör invazyonları ve/veya iyatrojenik geniş kemik rezeksiyonları, orbita duvarı defektlerinin bilinen ana nedenleridir. Orbital duvar defektlerinin rekonstrüksiyonunda estetik problemlerin yanında, enoftalmi veya distopi gibi klinik açıdan anlamlı fonksiyonel oftalmik sorunların çözülmesi önemlidir.
Gereç ve Yöntem: Bu çalışma Bahçeşehir Üniversitesi (BAÜ) Rhoton Anatomi Laboratuvarından (İstanbul, Türkiye) temin edilen 4 kadın, 4 erkek ve 16 taraf orbital alan üzerinde yapıldı. Konumlandırma için Mayfield kafa tutucuları kullanıldı. Orbital duvar defektlerinin değiştirilmesinde ve zigomatik ark (ZA) otogreftlerinin uyum içinde sabitlenmesi için titanyum mini plak ve mini vida sistemleri kullanıldı.
Bulgular: Anatomik noktaların en iyi şekilde görüntülenmesi için en uygun konumlandırma prensipleri tanımlandı. ZA diseksiyonu için Al-Mefty'nin kranio-orbito-zigomatik yaklaşım insizyonunun Gillie ile modifikasyonu yapıldı. Mini plak/vida sistemleriyle tutturulmuş ZA otogreftinin başarılı ve uyumlu bir şekilde değiştirildi.
Sonuç: Farklı insizyon tekniklerinin modifikasyonları daha iyi bir görüntü elde edilmesini sağlayabilir. Komplikasyonları önlemek için seçilen anatomik bölgelerin ve komşulukların ayrıntılı anatomik tanımlarının yapılması önemlidir. ZA transpozisyonu, otogreftlerin bilinen diğer avantajlarıyla birlikte uygulanabilir, ekonomik bir teknik olabilir ve ayrıca acil durumlarda çok kullanışlı olabilir.
Anahtar Kelimeler
orbital rekonstruksiyon zigomatik ark cerrahi teknik nöroşirurji anatomi
Etik Beyan
Çalışmamız Bahçeşehir Üniversitesi Rhoton Anatomi Laboratuvarı’nda yapılmıştır. Çalışmamızda canlı hayvan veya insan denek olarak kullanılmamıştır. Bu nedenle etik kurul gereksinimi oluşmamıştır.
Destekleyen Kurum
Yoktur.
Teşekkür
Bahçeşehir Üniversitesi Rhoton Anatomi Laboratuvarı çalışanlarına teşekkür ederim.
Kaynakça
- Cohen LM, Habib LA, Yoon MK. Post-traumatic enophthalmos secondary to orbital fat atrophy: a volumetric analysis. Orbit. 2020 Sep 2;39(5):319–24.
- Choi A, Sisson A, Olson K, Sivam S. Predictors of Delayed Enophthalmos After Orbital Fractures: A Systematic Review. Facial Plast Surg Aesthetic Med. 2022 Oct 1;24(5):397–403.
- Rajkumar GC, Ashwin DP, Singh R, Prashanth R, Rudresh KB. Ocular Injuries Associated with Midface Fractures: A 5 Year Survey. J Maxillofac Oral Surg. 2015 Dec 27;14(4):925–9.
- Stanley RB, Sires BS, Funk GF, Nerad JA. Management of Displaced Lateral Orbital Wall Fractures Associated with Visual and Ocular Motility Disturbances. Plast Reconstr Surg. 1998 Sep;102(4):972–9.
- Manolidis S, Weeks BH, Kirby M, Scarlett M, Hollier L. Classification and Surgical Management of Orbital Fractures: Experience With 111 Orbital Reconstructions. J Craniofac Surg. 2002 Nov;13(6):726–37.
- McNichols CH, Hatef DA, Thornton JF, Cole PD, de Mitchell CAG, Hollier LH. A Paradigm Shift in Correcting Medial Orbital Fracture–Related Enophthalmos. J Craniofac Surg. 2012 May;23(3):762–6.
- Nilsson J, Nysjö J, Carlsson AP, Thor A. Comparison analysis of orbital shape and volume in unilateral fractured orbits. J Cranio-Maxillofacial Surg. 2018 Mar;46(3):381–7.
- Bontzos G, Papadaki E, Mazonakis M, Maris GT, Kapsala Z, Blazaki S, et al. Quantification of effective orbital volume and its association with axial length of the eye. A 3D-MRI study. Rom J Ophthalmol. 2019;63(4):360–6.
- Tadj A, Kimble FW. The Gillies Method for fractured zygomas. ANZ J Surg. 2003;73(1–2):49–54.
- Al-Mefty O. Supraorbital-Pterional Approach to Skull Base Lesions. Neurosurgery. 1987;21(4).
- Muñoz R, Gajos G, Bladimir J, Carvajal D, Luis A, Del Valle Speranza G. Protocol for mandibular reconstruction with zygomatic implants (zygomatic mandibular implant). Oral Maxillofac Surg. 2018 Mar 28;22(1):39–44.
- Czerwinski M, Ma S, Williams HB. Zygomatic Arch Deformation: An Anatomic and Clinical Study. J Oral Maxillofac Surg. 2008 Nov;66(11):2322–9.
- Thijs D, Menovsky T. The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application. World Neurosurg. 2021 Jul;151:102–9.
- Swanson E, Vercler C, Yaremchuk MJ, Gordon CR. Modified gillies approach for zygomatic arch fracture reduction in the setting of bicoronal exposure. J Craniofac Surg. 2012;23(3):859–62.
- af Geijerstam B, Hultman G, Bergström J, Stjärne P. Zygomatic Fractures Managed by Closed Reduction: An Analysis With Postoperative Computed Tomography Follow-Up Evaluating the Degree of Reduction and Remaining Dislocation. J Oral Maxillofac Surg. 2008 Nov;66(11):2302–7.
- Yamamoto K, Murakami K, Sugiura T, Fujimoto M, Inoue M, Kawakami M, et al. Clinical Analysis of Isolated Zygomatic Arch Fractures. J Oral Maxillofac Surg. 2007 Mar;65(3):457–61.
- Li S, Xiao C, Duan L, Fang C, Huang Y, Wang L. CT image-based computer-aided system for orbital prosthesis rehabilitation. Med Biol Eng Comput. 2015 Oct 23;53(10):943–50.
- Huang YH, Seelaus R, Zhao L, Patel PK, Cohen M. Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report. Int Med Case Rep J. 2016 Nov;Volume 9:341–5.
- Laure B, Louisy A, Joly A, Travers N, Listrat A, Pare A. Virtual 3D planning of osteotomies for craniosynostoses and complex craniofacial malformations. Neurochirurgie. 2019 Nov;65(5):269–78.
- Day KM, Gabrick KS, Sargent LA. Applications of Computer Technology in Complex Craniofacial Reconstruction. Plast Reconstr Surg - Glob Open. 2018 Mar;6(3):e1655.
- Anabtawi M, Thomas M, Lee NJ. The Use of Interlocking Polyetheretherketone (PEEK) Patient-Specific Facial Implants in the Treatment of Facial Deformities. A Retrospective Review of Ten Patients. J Oral Maxillofac Surg. 2021 May;79(5):1145.e1-1145.e9.
- Adam AADM, Zhi L, Bing LZ, Zhong Xing WU. Evaluation of Treatment of Zygomatic Bone and Zygomatic Arch Fractures: A Retrospective Study of 10 Years. J Maxillofac Oral Surg. 2012 Jun 28;11(2):171–6.
- Tianzhi Z, Yingwu S, Zijian Y, Yingxi W, Yafei X, Yunze Z, et al. A Modified Technique to Harvest Integrated Zygomatic Arch-Temporal Bone Flap: Clinical Experience. Neurol India. 2022;70(1):325–30.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Beyin ve Sinir Cerrahisi (Nöroşirurji) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Mart 2025 |
| Gönderilme Tarihi | 10 Mayıs 2024 |
| Kabul Tarihi | 12 Kasım 2024 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: 1 |
