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Vol. 19. Issue 4.
Pages 322-331 (January 2008)
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Vol. 19. Issue 4.
Pages 322-331 (January 2008)
Orbitotomías óseas mediante abordaje coronal: estudio retrospectivo de 87 lesiones intraorbitarias
Osseous orbitotomies using a coronal flap: A retrospective study of 87 intraorbital lesions
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P. Infante-Cossío
, M. Molina-Martínez, A. García-Perla, J.L. Gutiérrez-Pérez
Servicio de Cirugía Maxilofacial. Hospital Universitario Virgen del Rocío, Sevilla
F. Espín-Gálvez*, J. Romero Arce**
* Servicio de Cirugía Maxilofacial. Complejo Hospitalario Torrecárdenas, Almería
** Servicio de Neurocirugía. Hospital Universitario Virgen del Rocío, Sevilla
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Resumen
Objetivo

Presentar nuestra experiencia en 80 pacientes con tumores y lesiones intraorbitarias en los que se realizaron 87 orbitotomías óseas mediante abordaje coronal, durante un período de 12 años.

Material, métodos y resultados

El diagnóstico histológico más frecuente fue el hemangioma, y la localización anatómica más frecuente la retrobulbar intracónica. La presentación bilateral de lesiones ocurrió en 7 pacientes. Las orbitotomías más utilizadas fueron la lateral y supero-lateral (87,35%). En un 90,80% de los casos se realizó algún tipo de osteosíntesis, un 51,75% con placas bio-reabsorbibles. La exposición o rotura de la duramadre intraoperatoria ocurrió en 10 pacientes. Se recogieron 45 complicaciones postoperatorias transitorias y 21 permanentes, las más frecuentes fueron las nerviosas (diplopia y ptosis) que se resolvieron espontáneamente en su mayoría en un corto intervalo de tiempo. En 15 pacientes se requirió colaboración multidisciplinar con neurocirugía.

Conclusiones

La incisión coronal permite realizar cualquier orbitotomía ósea con seguridad, garantía y buen resultado estético y funcional. Las orbitotomías lateral y supero-lateral proporcionan un abordaje ideal extradural al espacio retrobulbar. El acceso al ápex, canal orbitario y zona medial nervio óptico requiere comúnmente un abordaje combinado neuroquirúrgico a través de fosa craneal anterior. La fijación de las orbitotomías mediante osteosíntesis biorreabsorbible constituye una alternativa a las placas de titanio, incluso puede ser de primera elección en la edad pediátrica. La morbilidad de esta cirugía es baja.

Palabras clave:
Órbita
Tumor
Cirugía de órbita
Incisión bicoronal
Orbitotomía
Placa reabsorbible
Summary
Objective

To present our experience in 80 patients with intraorbital tumours and lesions who underwent 87 osseous orbitotomies with coronal incision during a 12 year period.

Material, methods and results

Hemangioma was the most frequent histologic diagnosis, being the intraconical retrobulbar compartment the most common location. Bilateral presentation of lesions occurred in 7 patients. Lateral and supero-lateral orbitotomies were preferably applied (87.35%). In 90.80% of cases some kind of osteosynthesis was employed, 51.75% with bio-resorbable plates. Intraoperative exposure or dura mater breakage occurred in 10 patients. 45 transitory and 21 permanent postoperative complications were seen, being the nervous ones (diplopia and ptosis) the most frequent. Most of these were spontaneously solved in a short time period. 15 patients required multi-disciplinary collaboration with neurosurgery.

Conclusions

Coronal incision allows any bone orbitotomy, with security, guarantee and good aesthetic and functional results. Lateral and supero-lateral orbitotomies provide an ideal extradural approach to the retrobulbar compartment. An approach to the apex, orbital channel and medial compartment to the optic nerve, usually requires a combined neurosurgical approach through anterior cranial fossa. Orbitotomy fixation with bio-resorbable ostheosynthesis is an alternative to titanium plates. They can even be a first choice in paediatric age. The morbidity of this surgical technique is low.

Key words:
Orbit
Tumour
Orbital surgery
Bicoronal incision
Orbitotomy
Resorbable plate

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