上顎骨・頬骨・眼か底骨折にしょう毛下切開（ｓｕｂｃｉｌｉａｒｙ ｉｎｃｉｓｉｏｎ）を用いた治療経験

Abstract

We consider that the purpose of the treatment of maxillofacial bone fractures is not only to correct the dysfunction but also to reduce the aesthetic disturbance as much as possible. From this reason, we used a subciliary incision technique to approach the fracture lines of the orbital floor and infraorbital rim in 7 cases. One Le Fort I, II type, 2 blowout fractures, and 4 zygomatic bone fractures involving the infraorbital rim were included in our 7 cases. We obtained aesthetically and functionally good results with this subciliary incision technique.Originally developed as a blepharoplasty type of incision, the subciliary incision was developed by Converse et al for the treatment of maxillofacial bone fractures. There are many types of surgical approach to the orbital floor, but we used preferably a step incision where each layer of tissue of the lower eyelid is divided at a different level so as to be able to prevent an ectropion caused by scar contracture. This technique provides an excellent exposure of the entire orbital floor and the lower part of the lateral and medial walls.Classifying grossly, there are 4 incision techniques (orbital rim incision, lower eyelid incision, subciliary incision, and conjunctival incision) for the exposure of the orbital floor, infraorbital rim, and zygoma from the lower eyelid. We should decide the most suitable technique for each case depending on the basis of the extent, the state, and the time of fractures. It is important to acquire a good knowledge of each of the 4 incision techniques in order to make this choice. Our subciliary incision technique with the step incision had several advantages over the other methods, namely, a wide operative field, nearly invisible scars, and absence of complications. Therefore, we consider that this technique is very useful for the treatment of maxillofacial bone fractures.