緊急手術を要した眼窩下壁骨折の1例

A case of orbital floor fracture treated by emergency surgery

目的：外傷による眼窩壁骨折に対し，緊急手術を行った症例の報告。症例と経過：14歳，男子がクラブ活動中に喧嘩で右眼を殴打され，その直後に頭痛，嘔吐，右眼の高度の上下転障害が生じた。その翌日のCT検査で，右眼窩下壁が骨折し，下直筋の陰影が消失していた。右trapdoor型眼窩下壁骨折と診断し，受傷から27時間後に眼窩下壁骨折整復術を行った。眼窩下壁に眼窩下神経溝に沿う骨折線があり，下直筋は上顎洞に脱出し，絞扼されていた。脱出した組織を愛護的に整復し，骨膜を縫合した。眼球運動は正常化した。結論：若年者の眼窩壁骨折で，骨折線で筋肉が絞扼されている症例には緊急手術の適応がある。手術までの時間が短ければ組織の挫滅が少なく，機能が回復する可能性が大きくなる。

Purpose：To describe a case of orbital floor fracture treated by emergency restoration surgery. Case and Findings：A 14-year-old boy suffered blunt trauma to the right orbit while involved in a fight. He had headache,vomiting,and severely restricted vertical movement of his right eye. Computed tomography the following day showed fracture of orbital floor. The inferior rectus muscle was absent. He was diagnosed with trapdoor-type orbital floor fracture. He received emergency surgery 27 hours after the incident. A fracture line was present along the infraorbital neural crest of the orbital floor. The inferior rectus muscle had prolapsed into the maxillary sinus. The incarcerated orbital soft tissue along with the inferior rectus was restored followed by suture of infured periost. Eye movement became normal after surgery. Conclusion：Emergency surgery is indicated when incarceration of extraocular muscles is present in orbital floor fracture in juvenile persons. Early surgical repair is essential in the recovery of ocular motility.