Feasibility of navigation-assisted endoscopic transnasal optic nerve decompression for the treatment of traumatic optic neuropathy in patients with midfacial fractures

• 발행기관: 대한구강악안면외과학회
• 저자명: Taro Okui Tatsunori Sakamoto Ichiro Morikura Tatsuo Okui Kentaro Ayasaka Satoe Okuma Hiroto Tatsumi Takahiro Kanno
• 간행물 정보: 『대한구강악안면외과학회지』제50권 제5호, 273~284쪽, 전체 12쪽
• 주제분류: 의약학 > 일반외과학
• 파일형태: PDF
• 발행일자: 2024.10.31

국문 초록

Objectives: Traumatic optic neuropathy (TON), a relatively rare condition, can cause visual functional impairment and permanent functional damage. Surgeons should be familiar with its diagnostic criteria and treatment to effectively manage cases of facial trauma with TON. We investigated the feasibility of navigation-assisted endoscopic trans-nasal optic nerve decompression (ETOND) to treat TON in maxillofacial trauma patients. Patients and Methods: We retrospectively analyzed data from the clinical investigation of four consecutive patients, two males and two females with an average age of 75 years, with midfacial fractures and TON between April 2021 and September 2023. All patients had swelling and subcutaneous periorbital hemorrhage accompanied by optic nerve canal and zygomaticomaxillary complex fractures on the affected side. Three patients had lacerations on the lateral eyebrow or upper eyelid. All patients were evaluated by an ophthalmologist for visual impairment; two patients could see hand motion at a 30 cm distance, one patient could perceive light, and one did not have any loss of visual acuity. Among the four patients, three had visual impairment immediately after the injury, and one showed delayed impairment. Results: The patients were treated with navigation-assisted ETOND conducted by an endoscopic rhinologist. Three of the ETONDs were performed along with open reduction and internal fixation (ORIF); the other ETOND was delayed. Orbital reconstruction was performed in three patients. Steroid therapy was administered to two patients, one pre-operatively and one post-operatively. The two patients with pre-operative vision loss showed improved visual acuity post-operatively, and the two patients with no pre-operative visual impairment had no vision loss associated with ORIF for their midfacial fractures. No patient had post-operative complications. Conclusion: Navigation-assisted ETOND can be performed easily by endoscopic rhinologists; and prompt examination, diagnosis, and treatment are important in patients with facial trauma and TON.

목차

Ⅰ. Introduction

Ⅱ. Patients and Methods

Ⅲ. Results

Ⅳ. Discussion

Ⅴ. Conclusion

ORCID

Authors’ Contributions

Funding

Acknowledgements

Ethics Approval and Consent to Participate

Conflict of Interest

References

키워드

Traumatic optic neuropathy Optic nerve canal fracture Midfacial fracture Navigation-assisted endoscopic trans-nasal optic nerve decompression