Orbital space widening and subcranial osteotomy

Curing disease: Indication 1. The first and second degree distances are widened. 2, the sieve plate sagging is not obvious. Contraindications The third-degree gap is widened or the sieve plate is obviously drooping. Preoperative preparation 1. Complete the various preoperative examinations listed below to fully understand the local deformity and extent of the patient. (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, 2d before surgery, start with antibiotic droplets, nose, mouth, spray the mouth, and cut the nose hair. 4. Start using antibiotics and hemostasis drugs 1 day before surgery. 5, in advance with blood 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. Soft tissue incision and exposure A scalp coronal incision was taken, the same as the intracranial and extracranial combined approach. 2. Osteotomy and bone removal The operation is basically the same as the intracranial and extracranial combined approach, but it is not used for the osteotomy of the supracondylar and the dome, and strives not to enter the cranial cavity. The osteotomy line is similar to the U shape, with a bone protrusion in the forehead. Cut off the widened bones of the daytime as needed. The incision of the medial side wall, the sacral floor and the infraorbital bone is basically the same as the intracranial and extracranial combined approach. 3. Move two inside Move the sides of the bone that have been cut open to the inside and close together. The bones in the forehead are moved inside the sputum to prevent further movement. 4. Bone grafting, fixation The autogenous humerus or skull piece was transplanted into the lateral bone space after the internal movement of the two jaws, and fixed with a wire. complication 1, cerebrospinal fluid leakage The main reason is that the dura mater or the cranial cavity is damaged when the bone is incision. Small laceration of the dura mater is expected to be closed by itself. 2, hematoma The main reason is that the hemostasis during the operation is not complete or the drainage tube is not placed.