supraorbital tumor resection

Treatment of diseases: orbital fibrosarcoma orbital sarcoma Indication Upper iliac tumor resection is applicable to: 1. The tumor located in the upper part of the eyelid, especially in the posterior part of the eyelid, is suitable for upper tumor resection. 2. Tumors located outside and behind the eyelids are suitable for external tumor resection. 3. The deep tumor on the medial side of the hernia is suitable for medial tumor resection. 4. Tumors that extensively invade the eyelids are suitable for total hernia resection or a larger range of surgery. Contraindications 1. Patients with undifferentiated carcinoma, adenoid cystic carcinoma and malignant melanoma in the cranial region have been extensively violated. 2. There are distant metastases or generalized conditions that cannot tolerate surgery. Preoperative preparation 1. Complete the various preoperative examinations listed below to fully understand the patient's local deformity and extent. (1) Clinical examination: Various measurements are made on the above-mentioned malformations, and other abnormalities of the face are examined and described. (2) Ophthalmic examination: including vision, light reflection, eye movement and fundus. Also pay attention to the presence or absence of strabismus. Visual field and eyeball protrusion should be checked. (3) Nasal examination: pay attention to the situation in the nasal cavity, whether there is a nasal septum deviation, whether there is brain swelling, whether the smell is normal or not. (4) Neurosurgical examination: According to the clinical needs, exercise function examination, EEG or angiography can be performed. (5) Radiation examination: The conventional skull radiography examination of the anterior and posterior position can show that the pupil distance is too wide, and it can also show the vertical asymmetry. The inner side wall and the outer side wall of the crucible can be displayed on the base tomographic X-ray sheet, such as length, thickness, degree of displacement, and angle. If the distance between the inner side walls of the two sides is the same as before and after, even if the front is narrow and wide, the operation is difficult. Generally it is wide before the front and narrow. The distance between the optic nerve holes on both sides can also be displayed on the tomographic radiograph. The anterior and posterior tomographic X-ray films show the condition of the superior and inferior wall of the ankle. Pay attention to the position of the sieve plate from the X-ray film. Patients with widened distances often have a sieve plate prolapse. At the same time, the development and extent of frontal sinus and ethmoid sinus The CT film provides clear images of the brain, ventricles, and sputum and helps to design surgical procedures and postoperative complications. 2. Complete liver, kidney, heart, lung function tests and blood biochemistry, blood gas and other related tests to understand the patient's overall condition. 3. 2 days before surgery, start with antibiotic droplets, nose, mouth, spray the mouth, and cut the nose hair. 4. Start antibiotics and hemostasis drugs 1 day before surgery. 5. Early blood matching 2000 ~ 3000ml spare. 6. Wash your hair and take a shower. Wash the head with 1:1000 chlorin, and shave the head. Surgical procedure 1. Incision, craniotomy and osteotomy The crown scalp flap was turned over, the semi-frontal bone flap was removed, the frontal lobe of the brain was pushed, the anterior cranial fossa was revealed, and the upper part of the ankle and the top of the dome were removed with a bone knife. 2. Reveal the tumor The sputum has been completely exposed and can be cut open to the tumor. 3. Resection of the tumor The tumor is removed through an incision in the periosteum. 4. Close the defect The soft tissue incision was sutured in layers. 5. Bone block reduction, wire fixation, closed coronary valve, negative pressure drainage complication Death Surgery mortality has been reported as high as 3% to 7.1%. Common causes of surgical death are cerebral edema, excessive blood loss, and postoperative intracranial infection. Precautionary measures are to make a careful surgical plan before surgery, careful operation during surgery, reduce surgical bleeding, pay attention to hemostasis and timely blood transfusion, maintain effective blood volume and maintain blood pressure at normal levels, timely prevent and treat brain edema, use high-efficiency, broad-spectrum antibiotics to prevent infection . 2. Brain edema The main causes are intraoperative breathing, cardiac arrest and ventilatory disorders (causing hypoxia and carbon dioxide accumulation), excessive craniotomy and intraoperative compression or overstretching of brain tissue. In order to prevent cerebral edema, surgical trauma should be reduced, operation time should be shortened, intraoperative airway should be kept unobstructed, and ventilatory dysfunction should be prevented or released in time. Oxygen should be given to avoid cerebral hypoxia. 20% mannitol 250-500 ml should be given before craniotomy. , lateral ventricle puncture, or directly cut the dura mater, appropriate release of cerebrospinal fluid, suture the dural incision after surgery, do not make a solid fixation when the frontal bone flap is placed back, only a few needles periosteal suture, and can be placed on the temporal side of the bone plate The edge bite off some bones, so that there is room for buffering postoperative cerebral edema. It is not advisable to over-tighten the head wound dressing to prevent the frontal bone plate from being sunken. If necessary, the head bandage should be removed, and the fluid input should be controlled after surgery. Intravenous infusion of 20% mannitol 250ml, 2 ~ 3 / d, for 3d. 3. Insufficient ventilation of the respiratory tract The main reason is that the two sides of the nose are close together in the operation, resulting in poor ventilation of the nasal cavity, or due to swelling of the nasal mucosa after surgery. During surgery, the hypertrophy of the turbinate should be removed or the thickened, curved septal cartilage should be removed, or even the entire septum. It is also possible to bite off the edge of the plow hole that moves inside on both sides. After the operation, the two nostrils were built into the appropriate size of the snorkel for 5 to 7 days. If necessary, make a tracheostomy, and extubate the tube after the swelling subsides after surgery. 4. tilt The movement of the two jaws after the osteotomy is based on the extent of displacement of the medial aspect of the ankle. If the walls of the jaws move at the same distance, the simple rotation of the eyelids around the longitudinal axis will cause the outer sidewall of the jaw to protrude forward. The main cause of squatting is the lateral and lateral pull of the lateral wall when the eyelid is displaced inward (the latter comes from the residual tension in different structures), the postoperative scar contraction, and the role of the orbicularis muscle. Prevention: When separating the iliac crest, it is necessary to avoid the separation of the medial malleolar ligament. The inner wall of the iliac crest should be removed, that is, a small wedge-shaped bone wall should be cut off from the dome to the inner wall of the iliac crest, so that the anterior wall of the iliac crest is the smallest, thus reducing the two Awkward pull. 5. Internal displacement The reason was that the iliac ligament was removed during the operation and no internal fixation was performed. Prevention: Try to keep the normal iliac crest of the medial malleolus ligament during surgery to avoid stripping the medial malleolus ligament. If it has been stripped, it should be used for internal fixation. 6. The ptosis The reason is that the anterior protrusion of the levator levator or the truss during the operation causes the upper eyelid to lose the support of the eyeball, or the outer iliac crest is displaced downward, so that the outer side wall portion of the upper jaw is moved downward to form a sag. Be careful not to damage the upper levator musculature during surgery. When the wall is peeled off along the aponeurosis, it can prevent damage to the levator levator. Be careful not to make the protrusion when moving the truss inside. 7. Eyeball invagination The reason is that the outer side wall of the ankle protrudes forward, causing the eyeball to retreat. It can also be caused by the release of fat from the sputum into the ineffective cavity outside the sputum. The removal of a small wall of the crucible on the inner side wall of the crucible improves the extent of the protrusion of the outer side wall of the crucible. Close the bone defect of the eyelid to prevent fat from coming out.