両眼の眼窩下壁骨折に対して上顎洞内バルーン挿入および骨膜移植術を施行した1例

A case of bilateral orbital floor fracture treated by periosteum transplantation and insertion of balloon into the maxillary sinus

　24歳男性が暴行で顔面を殴打された。視力は良好で，前眼部には球結膜出血以外に異常はなかった。眼球運動障害があり，全方向に複視があった。両眼とも，上転と下転が制限され，両側の三叉神経第2枝領域に知覚鈍麻があった。画像診断で両側の眼窩下壁に骨欠損型の骨折があった。治療として，全身麻酔下で両側の眼窩下壁骨折を整復した。眼窩側から嵌頓組織を整復し，骨折部に脛骨から採取した骨膜を移植し，上顎洞内にバルーンを2週間留置した。6か月後に複視は消失した。今回の術式は，眼窩下壁骨折に有効な方法の1つである。

　A 24-year-male was hit repeatedly on his face while involved in a fight. When seen the same day,his visual acuity was full with minimum pathological findings in the external eye. Both eyes showed restricted motility toward upper and lower directions. Bilateral hypesthesia was present in the area served by the second branch of trigeminal nerve. Diagnostic imaging showed bilateral defect and fracture of orbital floor. The fractured orbital floor was reconstructed by repositioning of the intraorbitally herniated tissue,transplantation of periosteum from the tibia,and insertion of inflated balloon in the maxillary sinus for 2 weeks. Diplopia disappeared 6months later. Above procedure is recommended as an effective one for blowout fracture of the orbital floor.