medial orbitotomy

The medial opening of the sinus is generally required to remove part of the ethmoid sinus to enlarge the surgical field. Therefore, it is also called medial orbitotomy via ethmoidal sinus because the medial approach to the medial approach is narrow, and opening part of the ethmoid sinus can enlarge the surgical field. For the operation of surgery, also known as Smith surgery. Treatment of diseases: ethmoid sinus malignant tumor Indication 1. A tumor on the medial side of the optic nerve or inside the medial rectus. 2. Tumors on the medial side of the optic nerve. 3. Sinus mucinous cysts, osteoma. Surgical procedure 1. Incision and peeling The skin incision is 4 mm from the medial malleolus. The upper end of the incision is on the inside of the incision on the palate, and the lower end is at the lower end of the lacrimal sac at the junction of the inferior and inferior wall, with a total length of 2 cm. Cut the skin and subcutaneous tissue to the periosteum. Distractor, enlarge the incision and stop bleeding, cut the periosteum, use the periosteal stripper to separate the internal structure of the sacral ligament, such as the lacrimal sac and the medial malleolar ligament, to expose the nasal bone, the maxillary frontal process and the sieving board. Structural damage such as medial malleolar ligament and lacrimal sac. When separating to the posterior part of the iliac crest, the pre-screening, post-surgical arteries and nerves are ligated or electrocoagulated and then cut. 2. Excision of bones Use a bone chisel to remove part of the maxillary frontal process, bite the posterior sieving board and part of the air chamber, and scrape the mucosa in the sinus sinus. You can also use the vascular clamp to penetrate the ethmoid sinus, and then use the maxillary sinus bite to remove the maxillary frontal process. The range of the maxillary frontal excision: the upper boundary is the nasal frontal suture (higher than the suture and the horizontal plate of the ethmoid); the lower boundary is the middle of the lacrimal sac, and the inner side can retain a narrow plate connected to the nasal bone, not to the nasal cavity. The same. The scope of ethmoid sinus resection: the upper boundary does not exceed the nasal forehead; the posterior boundary can reach the posterior mesh (the posterior mesh is about 5 mm from the front end of the optic nerve hole). If the tumor has no obvious adhesion and small volume, such as cavernous hemangioma, single cystic venous hemangioma, etc., can not remove the bone, directly cut the periosteum into the sputum. 3. Open the periosteum of the iliac crest and cut the periosteum horizontally from the anterior aspect of the iliac crest. If the incision is small, the incision can be cut into a "" shape or a "" shape, and then the suture is marked at the periosteal incision. After the periosteal incision, the second surgical space is fat-extracted, and the fat of the medial rectus muscle can be seen by pulling the fat to both sides. According to the position of the tumor in the upper and lower rectus, the intermuscular membrane is cut from the medial or lower rectus muscle and enters the muscle cone. 4. Delivery of tumors Because this approach directly exposes the inner side of the optic nerve, it is not necessary to pull the optic nerve during surgery, so it is safer. Tumors are isolated and delivered after exposure to the tumor. Heavier adhesions, such as schwannomas, can be performed intracapsular resection or block resection. 5. Stitch suture the periosteum with 5-0 gut, and try to put the extracted fat into the sputum (otherwise, it may lead to postoperative retraction of the eyeball), and tightly and accurately suture the medial periosteum, especially the medial malleolar ligament and the trochlear Periosteum. Generally, the anterior periosteum is easier to suture, and the posterior periosteum is not easy to suture due to peeling or sputum fat interference, but the periosteum should be sutured as much as possible to prevent the decompression effect caused by fat protruding after the ethmoid sinus. When suturing the periosteum, it should be operated under direct vision to prevent damage to the inner rectus muscle or suture. Prevention method: The inner rectus muscle is pulled after marking the suture at the conjunctiva, which is beneficial to suture of the periosteum and avoid damage. Tightly suturing the subcutaneous tissue reduces the tension of the subcutaneous tissue. The skin is sutured intradermally to reduce scarring, maintain a good appearance, and compress the dressing after suturing.