Orbital stenosis correction

Curing disease: Indication 1, the child's distance is <15mm. 2, 12-year-old children's distance <22mm. Contraindications 1. Children with mental retardation or dementia. 2, the general condition is poor, can not tolerate the operator. 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 First, the incision and exposure A bilateral coronal incision is made, starting from the frontal bone and turning the frontal flap along the periosteum to reach the upper palate. Open the skull and cut the frontal bone flap to reveal the anterior cranial fossa. Make a lower incision under the eyelashes. Peel the periosteum around the ankle until it is 10 mm from the tip. Second, osteotomy 1. Bone incision outside the iliac crest: a transverse bone incision is made along a plane 15 mm above the upper edge of the iliac crest. The lateral end of the osteotomy line stops at a point at the axilla, which intersects the lateral wall of the ankle. From this point, the bone is cut down through the sphenoid bone and the tibia. Then turn to the inside for the transverse incision line, under the lower hole, and inward to the edge of the plow hole. Two vertical parallel bone incision lines are made on both sides of the nasal bone, and the lateral edge of the maxillary bone reaches the outer edge of the plow hole. 2. Bone incision in the iliac crest: Use a power drill and a right-angled microsaw to slash the dome at the front 2/3 of the dome and then extend downwards through the tear groove. Then, the sawing is opened horizontally, across the underarm and split, and connected to the incision line of the lateral wall of the ankle. 3. Incision of the medial and lateral bones of the dome plane: the anterior and posterior bones are cut along the outer side of the sieve plate, and the front end meets the incision line of the upper iliac crest, and the posterior end of the transverse bone of the crest is cut. Pick up. A thin piece of bone is removed from each of the outer portions of each side of the dome. Third, mobile and bone grafting Move the eyelids on both sides to the right and left to the appropriate position. A small iliac crest is implanted in the defect of the dome and nasal area. complication 1, 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 relieved, oxygen should be given, and cerebral hypoxia should be avoided. 20% mannitol 250-500 ml should be given before craniotomy, and intravenous input should be fast. ; 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; the head wound dressing should not be too tight, prevent the frontal bone plate from being sunken, and if necessary, remove the head bandage; the fluid input should be controlled after surgery. Intravenous infusion of 20% mannitol 250ml, 2 ~ 3 / d, for 3d. 3, poor 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, tilting 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 wall of the iliac crest, avoid separating the medial malleolus ligament; to remove part of the inner wall of the iliac crest, that is, cut off a small piece of wedge-shaped bone wall from the dome to the inner side wall of the iliac crest, so that the anterior wall of the iliac crest is the smallest, thus reducing the two Awkward pull.