Retrobulbar Hematoma, Orbital Blowout Fracture, ne Aniwa a Ɛma Aniwa no Mu Yare¶

Sɛ wɔbɔ aniwa no akuturuku, baseball anaa nsateaa abɔ w’anim, obi ahwe ase, anaasɛ kar ahwe ase akyi no, aniwa a ɛyɛ yaw kɛse, ɛyɛ den te sɛ ɔbotan, a ɛyɛ kurukuruwa (proptosis) a ɛma wohu ade a ɛhwe ase no yɛ oprehyɛn a egye ntɛmpɛ a egye bere a wonim no sɛ Orbital Compartment Syndrome (OCS) a efi Retrobulbar Hematoma mu. Esiane sɛ onipa aniwa a ɛwɔ aniwa no mu (kyinhyia) yɛ nnompe adaka a ɛyɛ den a ɛwɔ afasu anan a ebue wɔ anim nkutoo nti, mogya a ɛtɔ kɔ aniwa no akyi no ma nhyɛso a ɛwɔ aniwa no mu no kɔ soro ntɛmntɛm sen aniwa no mu ntini a ɛwɔ mfinimfini no nhyɛso, na ɛbɔ retina ne aniwa ntini no mu wɔ simma 60 kosi 120 mu. Sɛ mogya a ɛkɔ akyi no nni hɔ mpo a, aniwa no mu nnompe a ɛyɛ tratraa a abubu (Orbital Blowout Fracture) betumi akyere ntini a ɛma aniwa no kɔ soro no, na ama koma no ayɛ brɛoo (oculocardiac reflex), anaasɛ ahyɛ sinus mframa wɔ aniwa no akyi sɛ onipa no bɔ ne hwene a. Sɛ obiara a n’anim anaa n’ani ayɛ no yaw no nya aniwa a ayɛ kurukuruwa, onhu ade yiye, onhu ade mprenu, ne ho yɛ no yaw a ne koma bɔ brɛoo, anaasɛ n’anofafa ne n’afono atifi yɛ mmerɛw a, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ ntɛm ara fa so nɔma ahorow a egye ntɛmpɛ. Hwɛ trauma protocol ahorow a ɛfa ho wɔ aniwa mu opira ne ɔhwɛ a egye ntɛmpɛ, . ti a opira ne akisikuru, na orbital cellulitis ne cavernous sinus thrombosis a ɛma mogya tu.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara (911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom) sɛ aniwa a apira no rehuruhuruw akɔ n’anim (proptosis), ɛte nka sɛ ɛyɛ den na ɛyɛ den te sɛ ɔbotan wɔ aniwa a ahonhon ase, n’aniwa nhu ade yiye anaasɛ ɛreyɛ sum, ɔwɔ aniwa a n’ani so ntew sɛnea ɛsɛ bere a hann hyerɛn wɔ mu, anaasɛ entumi nkɔ baabiara a kɔ soro a ɛyaw a emu yɛ den ne akisikuru nni mu.
2. Fa ɔyarefo no tena hɔ gyina hɔ (anyɛ yiye koraa no digrii 45 kosi 90) sɛ wonsusuw sɛ wapira akyi berɛmo mu a. Sɛ woma ti no kɔ soro sen koma no a, ɛde tumi a ɛtwe ade ba fam di dwuma de brɛ mogya a ɛba ntini mu ne ntini a ɛyɛ den wɔ aniwa no mu no ase, na ɛma retrobulbar hematoma a ɛboaboa ano no brɛ ase.
3. Hye ɔyarefo no katee sɛ: "MMƆ WO HWENE, nfefe a w'ano ato mu, na nhyɛ wo ho." Orbital blowout fracture paapae dompe a ɛyɛ tratraa te sɛ krataa a ɛtetew aniwa no mu ne maxillary ne ethmoid sinuses a mframa ahyɛ mu ma no mu. Hwene no a wɔbɔ no yɛ adwuma te sɛ mframa pɔmpɛ a nhyɛso kɛse wom, na ɛhyɛ sinus mframa ma fa mpaapaemu a abubu no mu wɔ aniwa no akyi pɛɛ (tension orbital emphysema), a ebetumi abu aniwa no ani ntɛm ara denam aniwa ntini no a ɛtwetwe no so.
4. Hwɛ anisoadehunu a ɛwɔ aniwa a apira no mu seesei ara (kata aniwa a enpira no so) na san yɛ nhwehwɛmu no simma 10 biara. Ma onipa no nkenkan nkyerɛwee, kan nsateaa dodoɔ a wokura mu, anaa ka sɛ ebia ɔbɛtumi ahunu nsa a ɛretu anaa hann. Sɛ aniwa mu ahoɔden so tew fi nkrataa akenkan so kɔ nsateaa a wɔkan nkutoo so bere a wɔabɔ w’anim akyi a, ka kyerɛ nnuruyɛfo a wɔboa nkurɔfo ne oduruyɛfo a ɔhwɛ ayarefo a wɔwɔ ayaresa a egye ntɛmpɛ mu no simma pɔtee a anisoadehu fii ase so tew enti wɔyɛ mpa ho ntɛm ara Lateral Canthotomy and Cantholysis (LCC) wɔ simma 90 ischemic window no mu.
5. Fa kyɛm a ɛyɛ den a ɛwɔ ahwehwɛ (anaasɛ krataa/foam kuruwa ase a wɔde teyp abɔ aniwa dompe ne anim dompe so) a ZERO nhyɛso wɔ aniwa no so bɔ aniwa no ho ban. Mfa aduru a ɛyɛ den nkyekyere aniwa a ayɛ basaa no denneennen da, na mfa nsukyenee a wɔde ahyɛ mu nhyɛ aniwa a ahonhon so tẽẽ da; sɛ nusu bi a wɔanhu wɔ aniwa no fasu mu (open globe injury) anaasɛ retrobulbar hematoma a, abɔnten nhyɛso bɛpiapia aniwa no mu nneɛma afi mu anaasɛ ɛbɛma aniwa ntini mu ischemia ayɛ ntɛmntɛm.
6. Ma ɔyarefo no nnyɛ hwee koraa wɔ ano (NPO) na sa akisikuru anaa ɔfe ntɛm ara. Ɔfe ne akisikuru ma ntini ne ntini mu nhyɛso a ɛkɔ soro denneennen wɔ ti ne aniwa no mu, ɛma mogya a ɛba akyi no trɛw, na ayarefo a wɔn aniwa ntini akyea anaasɛ wɔn mogya a ɛwɔ akyi no taa hia oprehyɛn a wɔde yi wɔn ho fi oprehyɛn dan mu ntɛm ara.

Gyinaesi dua: Triage a ɛyɛ blunt periorbital trauma, proptosis, ne blowout fractures¶

flowchart TD
    Start["Blunt Trauma to Eye, Cheek, anaa Forehead (Akuturuku, Bɔɔl, Ahwease, anaa Kwan) ."] --> GlobeCheck{"Anamɔn 1: Yi Open Globe Rupture (Nsu a ɛtɔ/aniwa a ɛyɛ ne sorosoro, aniwa a ɛyɛ tuntum a ɛpuepue, aniwa a ɛyɛ mogya a ɛyɛ digrii 360, anaa aniwa a mframa fi mu) no fi hɔ?"}

    GlobeCheck -->|"YIW: Wosusuw sɛ Open Globe Paapae"| OpenGlobe["OPEN GLOBE PROTOCOL: 1. Nhyɛso a ɛba aniwa so ZERO; MMFA aniwa mu nhyɛso (tonometry) nhwɛ. 2. Fa teyp a ɛyɛ den Fox aniwa kyɛm anaa krataa kuruwa gu nnompe rim so. 3. Frɛ 911 / 112 / 999 ma ntɛmpɛ aniwa ho oprehyɛn microsurgical repair, IV antibiotics, & antiemetics."]

    GlobeCheck -->|"DABI: Ɛda adi sɛ Globe Ɔfasu no Nsakrae"| OCSCheck{"Anamɔn 2: Screen for Orbital Compartment Syndrome (Retrobulbar Hematoma): Aniwa a ɛyɛ yaw a ɛbɔ (proptosis), aniwa a ɛyɛ den a ɛyɛ den te sɛ ɔbotan, aniwa a ɛhwe ase, anaasɛ aniwa a ɛyɛ brɛoo (RAPD)?"}

    OCSCheck -->|"YIW: Retrobulbar Hematoma / Aniwa mu Nneɛma a Wɔde Yɛ Adwuma"| Canthotomy["90-MINUT OPARO A WƆYƐ NTƐM: 1. Frɛ 911 / 112 / 999 Ntɛm ara; tra ase gyina hɔ digrii 45-90. 2. Bɔ ER Oduruyɛfo kɔkɔ bere a woadu hɔ no: Ɛhia sɛ wɔyɛ Mpa ho Lateral Canthotomy & Cantholysis Ntɛm ara ansa na wɔayɛ CT Scan. 3. Fa IV Mannitol / Acetazolamide / Methylprednisolone ma sɛ bridge."]

    OCSCheck -->|"DABI: Anisoadehu a Ɛfata, Kyinhyia a Ɛyɛ Dwo, Proptosis Biara Nni Hɔ"| MuscleTrapCheck{"Anamɔn 3: Hwɛ Extraocular Eye Movements (Hwɛ Ɔsoro, Fam, Benkum, Nifa): So wɔabara Upward Gaze a wohu ade mprenu, ANAA nea ɛka ho ne akisikuru, ɔfe, ne koma a ɛbɔ brɛoo (<60 bpm)?"}

    MuscleTrapCheck -->|"YIW: Anohyeto a Wɔde Hwɛ Ɔsoro + Bradycardia/Nausea (Titiriw wɔ Abofra/Mmabun a ‘White Eye’) ."| Trapdoor["TRAPDOOR ORBITAL FLOOR FRACTURE NE NNIPA A WƆAKYERƐW: 1. Emergency Department Orbital CT Scan MPREMPREN. 2. Hwɛ ECG so hwɛ sɛ Oculocardiac Reflex (vagal bradycardia/koma siw) anaa. 3. Ɛhwehwɛ sɛ wɔyɛ oprehyɛn gyae ntɛm ara wɔ nnɔnhwerew 24 kosi 48 ntam na wɔasiw ntini a ɛbɛwuwu daa no ano."]

    MuscleTrapCheck -->|"NO Ntini a Ɛkyere anaa Bradycardia BIARA NNI HƆ"| SimpleBlowout["SUSUSUSU A UNCOMPLICATED ORBITAL BLOWOUT FRACTURE (Aniwa a akɔ fam / enophthalmos, anim a ɛyɛ mmerɛw/anofafa a ɛwɔ soro, anaa crepitus): 1. Strictly NO hwene a ɛbɔ adapɛn 4 kosi 6. 2. Ntɛmntɛm Emergency Department CT of Orbits de hwɛ sɛnea abubu no kɛse ne sinus ahorow."]

Pathophysiology: Sɛnea aniwa no mu dan no bɛyɛ pressure cooker a edi awu¶

1. Nnompe no kyinhyia ne canthal ntini no nipadua a ɛyɛ den¶

Sɛ wopɛ sɛ wote nea enti a mogya anaa mframa kakraa bi a wɔaboaboa ano wɔ aniwa akyi no ma anifurae ba ntɛmntɛm saa no ase a, susuw mfiri a wɔde yɛ onipa kyinhyia no ho hwɛ: - Nnompe Fasu Anan a Ɛyɛ Den: Aniwa no yɛ pyramid a ɛte sɛ pear, a ɛwɔ afã anan a sɛ wɔkyekyem pɛpɛɛpɛ a, emu duru yɛ 30 mililita (\(30\text{ mL}\)) pɛ, a wɔato mu wɔ soro (anim dompe / orbital roof), abɔnten (zygomatic ne sphenoid nnompe / akyi ɔfasu), ase (maxilla / orbital fam), ne mu (ethmoid ne nusu nnompe / mfinimfini ɔfasu). - Anim Pon a Wɔatoto Mu: Wɔ pyramid no anim bue no atifi no, wɔde nhama a ɛyɛ den (orbital septum) kura aniwa no mu (globe) ne orbital fat no mu denneennen wɔ socket no mu na wɔde medial canthal tendon ne lateral canthal tendon (titiriw ne inferior ne superior no abɔ nnompe no ho te sɛ guitar hama crura) na ɛyɛe. - Volume-Pressure Compliance Curve: Mpɛn pii no, ahomegye mu nhyɛso a ɛwɔ aniwa mu ne aniwa mu (IOP) yɛ mercury milimita 10 kosi 20 (\(\text{mmHg}\)). Esiane sɛ nnompe afasu no ntumi ntrɛw nkɔ akyi na akyi canthal tendon no mma aniwa no ntumi nkɔ n’anim bɛboro milimita kakraa bi nti, kyinhyia no tumi fa nsu a ɛboro so bɛyɛ mililita 4 kosi 5 pɛ ansa na ntini a ɛyɛ mmerɛw nyinaa asa. - Sɛ infraorbital artery a apaapae, anterior anaa posterior ethmoidal artery, anaa ophthalmic artery branch no mogya bɛboro mililita 5 kɔ retrobulbar muscle cone no mu (anaasɛ wɔhyɛ sinus mframa ma ɛkɔ mu wɔ nhyɛso ase akyi) pɛ a, intraorbital pressure kɔ soro wɔ exponential curve so kodu 40, 60, anaa bɛboro 80 mmHg.

2. Ntini a ɛtwetwe ntini (Ocular Compartment Syndrome) .¶

Te sɛ acute compartment syndrome wɔ nan ase anaa nsateaa a wɔabubu mu (hwɛ crush opira ne compartment syndrome), bere a nhyɛso a ɛwɔ orbital compartment a wɔato mu no mu boro perfusion nhyɛso a ɛwɔ ntini nketewa a ɛma aniwa ne aniwa ntini no aduan no mu no: 1. Venous Outflow Collapse (\(>25\text{ to }30\text{ mmHg}\)): Wɔbɔ mfinimfini retina ntini a ɛwɔ ɔfasu teateaa ne vortex ntini no mu kan, na ɛkyere ntini mu mogya wɔ aniwa no mu na ɛma aniwa no mu ntini no mu yɛ den. 2. Short Posterior Ciliary and Vasa Nervorum Ischemia (\(>35\text{ to }45\text{ mmHg}\)): Ntini nketenkete a ɛma anim aniwa ntini ti ne retrobulbar aniwa ntini no hwe ase, na ɛde ischemic optic neuropathy ba. 3. Central Retinal Artery Occlusion (\(>60\text{ to }80\text{ mmHg}\)): Sɛ orbital ne intraocular pressure bɛn diastolic arterial blood pressure a, central retinal artery no gyae sen bere a diastole (wohu wɔ ophthalmoscope so sɛ central retinal artery a ɛrebɔ) na afei ɛto mu koraa. 4. Simma 60 kosi 120 Nkwa Mfɛnsere: Primate ne ayaresabea ahodwiriw ho nhwehwɛmu kyerɛ sɛ sɛ retinal ne optic nerve ischemia wie pɛ a, efi ase wɔ Orbital Compartment Syndrome mu a, oprehyɛn decompression a wɔyɛ wɔ simma 60 kosi 90 mu no ma ayarefo bɛboro ɔha biara mu nkyem 85 san hu ade yiye anaasɛ ɛkame ayɛ sɛ ɛyɛ nea ɛfata, bere a decompression kyɛ wɔ akyi no Simma 120 kosi 240 ( nnɔnhwerew 2 kosi 4) taa ma ɔyarefo no ani afura koraa wɔ saa aniwa no mu.

3. Mfiri a wɔde yɛ Orbital Blowout Fracture (Hydraulic vs. Buckling Theory) .¶

Dɛn nti na aniwa no mu fam anaa ɔfasu a ɛwɔ mu no mu paapae bere a nnompe a emu yɛ duru a atwa aniwa no akyi ho ahyia no ntumi mmubu? - The Hydraulic Mechanism: Sɛ ade kurukuruwa bi a ne kɛse boro sɛntimita 5 (nsateakwaa 2) (te sɛ nsateaa, baseball, kriket bɔɔl, anaa tɛnis bɔɔl) bɔ aniwa no anim a, ɛpia aniwa no kɔ akyi kɔ srade a ɛwɔ akyirikyiri a wontumi nhyɛ no den a ɛyɛ mililita 30 no mu. Saa nsu nhyɛso asorɔkye a ɛba mpofirim no pae kɔ abɔnten kɔ nnompe afasu anan no nyinaa so na ɛbɔ "ahobammɔ-valve" nnompe abien a ɛyɛ tratraa sen biara wɔ ti nhwi no mu no: 1. The Posterior-Medial Orbital Floor (Roof of the Maxillary Sinus): 0.5 millimeters pɛ, a ɛyɛ mmerɛw kɛse esiane groove ne canal a ɛde infraorbital nerve (\(V_2\)) no nti. 2. The Medial Orbital Wall (Lamina Papyracea of ​​the Ethmoid Sinus): Wɔkyerɛ ase ankasa sɛ "krataa a ɛyɛ tratraa" (a ne kɛse yɛ 0.2 kosi 0.4 milimita pɛ). - The Buckling Mechanism: Ɔhwe a wɔbɔ tẽẽ kɔ inferior orbital rim a ɛyɛ den (cheekbone edge) no so de mfiri shockwave kɔ akyi a ɛbɔ orbital fam a ɛyɛ tratraa no wɔ n’akyi tẽẽ a ɛnpaapae aniwa no ankasa.

Ntotoho a edi mũ a ɛfa 4 a emu yɛ den wɔ ahodwiriw akyi orbital ntɛmpɛ ho¶

Ayaresa ho akwankyerɛ a ɛkɔ akyiri a ɛfa 4 orbital trauma ntɛmpɛ ho¶

1. Retrobulbar Hematoma ne Mpa ho Akyi Canthotomy & Cantholysis (LCC) .¶

Dɛn nti na ayarefo a wɔwɔ retrobulbar hematoma no da so ara hwere wɔn ani wɔ nnɛyi ayaresabea ahorow mu? #1 nti a ɛte saa ne sɛ wobɛtwɛn orbital CT scan anaasɛ wobɛtwɛn sɛ wode Tono-Pen bɛsusu intraocular pressure ansa na woatwitwa lateral canthal tendon. - Clinical Diagnosis at the Bedside (No CT Required): Sɛ ɔyarefo bi a wayɛ basaa (anaasɛ ɔyarefo bi a ɔyɛɛ n’aniwa anim blepharoplasty, sinus oprehyɛn, anaasɛ retrobulbar anesthetic block nnansa yi ara) de "4 Ps of Orbital Compartment Syndrome" ba a: 1. Ɛyaw (ɛyaw a emu yɛ den, ɛyɛ yaw a emu dɔ wɔ orbital mu). 2. Proptosis (wiase no anim a ɛrehuruhuruw a ɛko tia dijitaal retropulsion a ɛyɛ brɛoo wɔ nkataso a wɔato mu so te sɛ ɔbotan). 3. Ani a ɛnyɛ ne kwan so (afferent pupillary defect [RAPD] wɔ swinging-flashlight sɔhwɛ no mu, anaasɛ aniwa a ɛtrɛw brɛoo). 4. Aniwa a Ɛnyɛ Yie / Ɛretew (anaasɛ wontumi nsusuw anisoadehu ho wɔ ɔyarefo a wɔde afiri a ɛma obi ho dwiriw no a ɔwɔ proptotic aniwa a ɛyɛ den te sɛ ɔbo a ɔwɔ RAPD anaa Intraocular Pressure \(>40\text{ mmHg}\)). - Sɛnea Lateral Canthotomy ne Inferior Cantholysis Gye Aniwa no Wɔ Simma 2 Mu: - Wɔ Emergency Department resuscitation bay no, oduruyɛfo no de lidocaine mililita 1 kosi 2 a epinephrine wom gu aniwa no akyi ntwea so (lateral canthus), de hemostat kyekyere akyi canthus no sikɔne 30 de bubu mogya ntini no mu, na ɔde iris scissors twa kwan a ɛkɔ soro a ne tenten yɛ sɛntimita 1 (canthotomy) a wɔde yɛ adwuma. - Nea enti a Canthotomy nkutoo Nnɔɔso: Sɛ wotwitwa were a ɛwɔ aniwa no ntwea so kɛkɛ a, ɛma orbital pressure so tew mercury milimita kakraa bi pɛ. Afei ɛsɛ sɛ oduruyɛfo no twe aniwa a ɛwɔ fam no fi aniwa no kurukuruwa no ho, de nkankyee no ano te nka ma inferior crus of the lateral canthal tendon a ɛyɛ den a ɛte sɛ guitar hama no, na ɔtwitwa saa ntini no koraa (inferior cantholysis). - Bere a wɔatwa crus a ɛwɔ fam no, aniwa a ɛwɔ fam no hwe ase koraa, aniwa no kɔ n’anim milimita 4 kosi 6 de brɛ retrobulbar space no ase, intraorbital pressure so tew kɛse 20 kosi 40 mmHg wɔ sikɔne kakraa bi mu, na mogya a ɛwɔ ntini mu no san de ahopere san kɔ mfinimfini retina artery ne optic nerve no mu.

2. Mmofra "White-Eyed" Trapdoor Fracture ne Oculocardiac Reflex a edi awu¶

Wɔ mmofra, mmabun, ne mpanyimfo nkumaa a wonnii mfe 20 mu no, collagen a ɛyɛ den pii wɔ orbital floor no nnompe mu na ennya nyɛɛ mmerɛw te sɛ mpanyimfo dompe: - Sɛ wɔde bɔɔl, ne nsateaa, anaa kotodwe bɔ abofra aniwa mu a, fam a ɛyɛ tratraa a ɛwɔ kyinhyia no mu no kotow kɔ fam te sɛ greenstick hinge, srade a ɛwɔ akyi no ne inferior rectus muscle (a ɛte fam tẽẽ) no herniate bere tiaa bi fa mpaapaemu no mu, na dompe a ɛyɛ den no san kɔ baabiara te sɛ afiri a spring ahyɛ mu ma, na ɛkyekyere inferior rectus no ntini a ɛyɛ den wɔ n’anom. - Nea Enti a Wɔanhu no Yiye sɛ Ɛyɛ Akisikuru: Esiane sɛ mmofra nnompe a ɛyɛ den no twetwe kɔ akyi yiye a ɛnsɛe nti, ɛtaa yɛ sɛ aniwa tuntum biara nni hɔ, mogya a ɛba aniwa no ase nni hɔ, na "ani fitaa" a ɛte sɛ nea ɛteɛ koraa wɔ akyi. Nanso, sɛ wɔtrɛw inferior rectus muscle a wɔabɔ no pintinn no mu a, ɛtow afferent sɛnkyerɛnne a emu yɛ den kɔ soro ophthalmic division of the trigeminal nerve (Cranial Nerve V) kɔ amemene no dua no mu, na ɛtow tẽẽ kɔ vagus nerve (Cranial Nerve X) kɔ koma ne yafunu mu (The Oculocardiac Reflex / Aschner Reflex). - The Concussion Trap: Esiane sɛ abofra no fe mpɛn pii, ne ho yɛ fifiri na ne ho fifiri, ɔte nka sɛ ne ti ayɛ no yaw/ɔda, na ne ti yɛ no yaw a n’ani te sɛ nea ɛte sɛ nea ɛte wɔ akyi nti, adwumayɛfo a wɔhwɛ ntɛmpɛ so taa hwehwɛ abofra no wɔ ɔkwan a ɛnteɛ so sɛ ɔwɔ ** .ti a opira anaasɛ akisikuru** na hyɛ sɛ wɔnyɛ amemene CT a ɛyera kyinhyia a ɛwɔ fam no. - Sɛnea Wobɛhunu No Ntɛm ara: Hwɛ abofra no koma bɔ (ɛtaa bɔ brɛoo kɛseɛ wɔ 35 kɔsi 55 simma biara, a junctional escape beats anaa sinus arrest spikes ka ho) na bisa abofra no sɛ ɔnni wo nsateaa akyi na ɔnhwɛ UP tẽẽ nkɔ soro. Sɛ aniwa a apira no ntumi nkyinkyin nkɔ soro ntwa mfinimfini kwan no ho na ɔhwɛ soro ma asorɔkye a ɛyɛ akisikuru, aniwa mu yaw, ne koma a ɛbɔ no so tew wɔ koma no so hwɛbea no so a, abofra no wɔ trapdoor orbital fracture a wɔakyere a ɛhwehwɛ sɛ wɔyɛ no oprehyɛn ntɛm ara wɔ ** nnɔnhwerew 24 kosi 48** ansa na ntini a wɔabɔ no no anya ischemic necrosis a ɛtra hɔ daa (Volkmann contracture of the eye ntini).

3. Infraorbital Nerve (\(V_2\)) Numbness: Nsɛnkyerɛnne a Ahintaw a Ɛkyerɛ sɛ Orbital Fam Abubu¶

Wobɛyɛ dɛn ahu wɔ baabi a akwanhyia asi no sɛ aniwa tuntum a ahonhon no yɛ ntini a ɛyɛ mmerɛw a akuru kɛkɛ ("shiner") anaasɛ nnompe a ɛwɔ ase orbital floor blowout fracture? - Fa wo nsateaa tu mmirika brɛoo fa onipa no benkum ne nifa ase hwene, hwene no fã, anofafa a ɛwɔ soro, na bisa wɔn sɛ wɔn anim sẽ a ɛwɔ soro no te nka sɛ "nnua" anaasɛ ɛyɛ mmerɛw (te sɛ bere a wɔatow Novocain tuo a wɔde sa sẽ akyi). - infraorbital nerve (trigeminal nerve no maxillary division no nkorabata bi, \(V_2\)) no fa nnompe kwan a ɛyɛ tratraa te sɛ krataa mu tẽẽ wɔ aniwa no fam ansa na afi adi akɔ hwene no so de atenka akɔ mfinimfini ne soro sẽ no mu. - Sɛ ɔhwe a ɛbɔ aniwa no ma ayɛ mmerɛw anaasɛ pin-ne-needles wɔ anofafa a ɛwɔ soro, atifi anom/se, ne anim wɔ ɔfã koro no ara a, orbital floor blowout fracture a ɛfa infraorbital canal no mu no wɔ hɔ kosi sɛ wɔbɛda no adi sɛ ɛnte saa denam orbital CT scan so.

4. Orbital Emphysema: Nea Enti a Hwene a Wɔbɔ no Dane Mframa a Ɛyɛ Mmerewa no Ma Ɛyɛ Mframa Kwan a Ɛkɔ Orbit no¶

Sɛ mfinimfini fasu (lamina papyracea) anaa fam a ɛwɔ orbit no mu no mu paapae a, afei de srade a ɛnyɛ sterile a ɛwɔ aniwa no mu no ne ethmoid anaa maxillary nasal sinuses a mframa ahyɛ mu ma no di nkitaho tẽẽ: - Wɔ ahome a ɛfata ase no, mframa a ɛwɔ hwene no mu no sua. - Nanso, wɔde ahoɔden bɔ hwene no ma nhyɛso a ɛwɔ anom a ɛyɛ 60 kosi bɛboro 100 mmHg (a ɛne kar tae a wɔde mframa bɔ no yɛ pɛ). - Saa mframa a ɛnyɛ sterile sinus ne mucus a ɛpae no tow fa dompe mu mpaapaemu no mu kɔ aniwa no mu (na ɛma aniwa no yɛ balloon mpofirim a "Rice Krispies" subcutaneous crepitus te nka wɔ wo nsateaa ase a ɛyɛ krak) ne aniwa no akyi. - Sɛ sinus mucosa anaa orbital fat no flap yɛ adwuma sɛ ball-valve (ɛma mframa kɔ mu bere a hwene no rebɔ nanso ɛkyere no sɛnea ɛbɛyɛ a entumi nsan nkɔ sinus no mu) a, mframa kotoku a akye no mia mfinimfini retina ntini ne aniwa ntini (Tension Orbital Emphysema), na ɛde anifurae a emu yɛ den a ɛhwehwɛ sɛ wɔde needle decompression fi retrobulbar mframa no mu ba ntɛm ara kotoku mu. - Bio nso, sɛ wɔhyɛ anom ntini mu mmoawa a efĩ wom ma wɔde wɔn ho hyɛ orbital srade a ɛnyɛ sterile no mu a, ɛde asiane kɛse ba sɛ ɛbɛma wɔahu ade ** .orbital cellulitis ne cavernous sinus thrombosis a ɛma mogya tu**, ɛno nti na wɔbara ayarefo a wɔn sinus-communicating orbital fractures no mmɔ wɔn hwene, scuba diving, anaa mmɔ mframa nnwinnade adapɛn 4 kosi 6.

Bere nyinaa pow Open Globe Rupture a ɛba bere koro mu ansa na wode wo nsa aka aniwa no¶

Bere biara a fist, baseball, BB pellet, bottle cork, anaa ahwehwɛ a abubu bɛbɔ aniwa no, tumi a ɛpaapae orbital nnompe no nso betumi apae aniwa no ankasa fasu (Open Globe Rupture). Ansa na wobɛma obiara kwan ma wamia aniwa no anim anaasɛ ɔbɛhwɛ sɛnea orbital tension no, hwɛ aniwa no mu wɔ w’ani so hwɛ sɛ Six Signs of an Open Globe Rupture: 1. A "Teardrop" anaa Peaked Pupil: Osuani no nyɛ kurukuruwa bio; wɔtwe no ma ɛyɛ nusu a ɛyɛ nsensanee a ɛkyerɛ ani anaa anim a ɛyɛ mmerɛw no ntwea so baabi a aniwa no fasu no paee na aniwa no siw tokuru no mu. 2. 360-Degree Bloody Ballooning of the Conjunctiva (Bullous Hemorrhagic Chemosis): Ntini a emu da hɔ a ɛwɔ aniwa no fitaa so no ahonhon ayɛ no ring a ɛyɛ den a mogya wom, te sɛ jelly a atwa ani no ho ahyia koraa, na ɛde scleral rupture bi asie ase. 3. Dark Brown anaa Black Pigment (Uveal Prolapse) Sticking Out of the White of the Eye: Mmɔ mmɔden da sɛ wobɛpopa tuntum anaa bruu tuntum "mfĩ beae" a ɛwɔ sclera no so wɔ ahodwiriw akyi; ɛyɛ ɔyarefo no iris anaa ciliary nipadua a ɛpuepue fa sclera a apaapae mu. 4. An Abnormally Deep or Shallow/Flat Anterior Chamber (anaa Hyphema): Mogya a ɛwɔ anim no akyi no yɛ ma (hyphema, hwɛ aniwa mu apirakuru) anaasɛ ɛte sɛ nea abubu bere a wɔde toto aniwa foforo no ho no. 5. Extrusion of Clear Jelly (Vitreous Humor) wɔ aniwa no ani. 6. Aniwa a Ɛyera Kɛse a Aniwa a Ɛyɛ Dwo, a Ɛte sɛ Nea Mframa Nsɛe.

Sɛ sɛnkyerɛnne BIARA a ɛkyerɛ sɛ globe a wɔabue mu apaapae wɔ hɔ a, gyae nipadua mu nsakrae nyinaa ntɛm ara, fa Fox kyɛm a ɛyɛ den a ɛwɔ adum anaa krataa kuruwa ase teyp so fa nnompe anim ne anim dompe a enni aniwa no so, ma ɔyarefo no ntra hɔ na ɔnyɛ komm, na frɛ 911 / 112 / 999.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

• United States ne Canada: Frɛ 911 na fa ntɛm ara kɔ Level I anaa Level II Trauma Center a ɛwɔ 24/7 Emergency Medicine ne Ophthalmology / Oculoplastic Surgery tumi. Wɔ American College of Emergency Physicians (ACEP), Advanced Trauma Life Support (ATLS), ne American Academy of Ophthalmology (AAO) akwankyerɛ ase no, wɔatete nnuruyɛfo a wɔhwɛ ntɛmpɛ so na wɔama wɔn adansedi krataa sɛ wɔnyɛ mpa ho ntɛm ara Lateral Canthotomy and Cantholysis (LCC) ansa na wɔayɛ CT mfoniniyɛ ama Orbital Compartment Syndrome.
• United Kingdom: Bɔ 999 (anaasɛ 112). Wɔ Royal College of Emergency Medicine (RCEM) ne Royal College of Ophthalmologists (RCOphth) adwenemhaw akwankyerɛ ase no, wɔde retrobulbar mogya a ɛtɔ a aniwa ntumi nhu no yɛ oprehyɛn a ɛma obi nya ahoɔden ntɛm ara a wɔyɛ no ntɛm ara wɔ Emergency Department Resuscitation Room ansa na wɔde radiology akɔma obi foforo.
• Europa Aman Nkabom: Dial 112. Di Europa Resuscitation Council (ERC) ne ɔman maxillofacial/ophthalmic trauma akwan akyi ma orbital decompression ntɛm ara ne maxillofacial CT angiography.
• Australia ne New Zealand: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand. Di RANZCO (Royal Australian and New Zealand College of Ophthalmologists) ne ANZCOR aniwa mu ahodwiriw akwankyerɛ akyi.
• India ne Asia-Pacific: Trɛ 112 wɔ India, 119 wɔ Japan ne South Korea, anaa 995 wɔ Singapore. Bisa sɛ wɔmfa wo nkɔ ayaresabea a wɔde CT mfoninitwa, mframa kwan/oprehyɛn a wɔde yɛ nnuru a egye ntɛmpɛ, ne aniwa ho ayaresa a wɔde tua ho ka ahyɛ mu tẽẽ.

Hwɛ nɔma ahorow a egye ntɛmpɛ ama amanaman ntam ntɛmpɛ a wɔde mena nɔma nyinaa.

Nsɛm a wɔtaa bisa¶

Dɛn nti na mintumi mfa nsukyenee a wɔde ahyɛ aniwa tuntum a ahonhon so tẽẽ bere a wɔabɔ no denneennen akyi pɛɛ?¶

Enkosi sɛ oduruyɛfo bi bɛhwɛ aniwa no mu na wasi so dua sɛ asase no fasu no nni dɛm na retrobulbar hematoma biara nni hɔ no, nsukyenee a wɔde ahyɛ mu mu duru a wɔde bɛto hɔ anaasɛ awɔw a wɔde mia aniwa no so tẽẽ no yɛ asiane. Sɛ scleral rupture (open globe) bi a ahintaw wɔ hɔ a, nsukyenee no mu duru betumi apiapia aniwa a ɛwɔ mu no ne vitreous jelly no afi aniwa no mu; sɛ retrobulbar hematoma wɔ hɔ a, abɔnten so nhyɛso de ka nhyɛso a ɛyɛ hu dedaw a ɛtwetwe aniwa ntini no ho. Bere nyinaa bɔ aniwa no ho ban wɔ nnompe no ano mmom.

Dɛn nti na m’aniwa puei te sɛ golf bɔɔl bere a mebɔɔ ​​me hwene bere a wɔbɔɔ m’anim akyi no?¶

Dompe a ɛtetew w’aniwa mu ne ase fi wo hwene mu ntini no mu no mu duru nnu milimita fã na ɛtaa paapae bere a w’anim ayɛ wo yaw pefee bere mpo a w’anim akyi yɛ fɛ no. Sɛ wobɔ wo hwene mu hwene mu de bɔ wo hwene a, woma mframa nhyɛso bɛboro 60 kosi 100 mmHg ba wo hwene mu, a ɛpae sinus mframa ne mmoawa fa saa dompe mu mpaapaemu no mu pɛɛ kɔ w’aniwa anim ne w’aniwa akyi (**orbital emphysema**); sɛ wohu ade yiye anaasɛ aniwa no te nka sɛ ɛyɛ den bere a woabɔ wo hwene akyi a, kɔ baabi a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ ntɛm ara.

Dɛn nti na wɔtaa hu abofra a ɔrefe a ne koma bɔ brɛoo bere a wabɔ n’ani akyi no wɔ ɔkwan a ɛnteɛ so sɛ ne ho popo?¶

Mmofra wɔ fam nnompe a ɛyɛ mmerɛw a ɛkyinkyin a ɛpaapae bere a wɔabɔ no na ɛpaapae kɔ akyi pɛɛ te sɛ afiri pon a spring ayɛ mu ma, na ɛbɔ rectus aniwa ntini a ɛwɔ fam no a ennyaw aniwa tuntum pii wɔ akyi. Saa aniwa ntini a akyea no a wɔtrɛw mu no kanyan trigeminal-vagal **oculocardiac reflex**, a ɛde akisikuru a emu yɛ den, ɔfe, honam ani yɛ fitaa, ɔbrɛ, ne koma bɔ brɛoo a asiane wom (bradycardia) ba. Bere nyinaa ka kyerɛ abofra biara a n’anim ayɛ basaa sɛ ɔnhwɛ soro tẽẽ nkɔ ɔdan no atifi; sɛ aniwa biako ntumi nkɔ soro a, ɛyɛ orbital fracture a wɔakyere, na ɛnyɛ akisikuru kɛkɛ.

So Lateral Canthotomy ne Cantholysis gyaw akuru a ɛyɛ mmerɛw daa wɔ aniwa no ntwea so?¶

Daabi; a bedside lateral canthotomy ne inferior cantholysis yɛ snip ketewaa bi a ɛho tew a ɛyɛ sɛntimita 1 wɔ aniwa no akyi abɔde mu nkuruwankuruwa a ɛwɔ baabi a aniwa ho oprehyɛn a wɔde yɛ ahosiesie taa twitwa. Sɛ akyi berɛmo no ho ahonhon no sa wɔ nna pii mu pɛ a, ɛnyɛ den sɛ aniwa ho oduruyɛfo anaa oprehyɛn a ɔyɛ aniwa no ho oprehyɛn betumi de akuru a ɛkame ayɛ sɛ wontumi nhu no asan apam ntini ne aniwa no ntwea so, bere a sɛ wɔantumi atwa no wɔ simma 90 mu a, ɛde anifurae a ɛtra hɔ daa a wontumi nsakra no ba.

So orbital blowout fractures nyinaa hia sɛ wɔyɛ oprehyɛn de prɛte bi hyɛ aniwa no mu?¶

Daabi; mpanyimfo orbital fam ne medial wall blowout abubu bɛboro fã sa dwoodwoo a wɔnyɛ oprehyɛn. Aniwa ho animdefo ne anim oprehyɛn ho animdefo yɛ oprehyɛn Ntɛm ara (wɔ nnɔnhwerew 24 kosi 48 mu) sɛ aniwa ntini bi de mfiri akɔto aniwa mu ntini bi a ɛde oculocardiac reflex anaasɛ aniwa abien a entumi nsiesie ba, anaasɛ Subacutely (wɔ nnafua 7 kosi 14 mu bere a ɔfe no akɔ fam pɛnkoro) sɛ akisikuru no kata orbital fam bɛboro ɔha biara mu nkyem 50 so a, . ɛma wohu ade abien a ɛkɔ so wɔ akenkan a wɔde hwɛ ade titiriw mu, anaasɛ ɛma aniwa no kɔ akyi (**enophthalmos**) bɛboro milimita 2.

So metumi de wimhyɛn akɔ wimhyɛn mu anaasɛ makɔ scuba diving a orbital blowout fracture a wɔansa no yare?¶

Mpɛn pii no, wimhyɛn adwumayɛkuw ne aniwa ho animdefo tu fo sɛ wɔntwɛn kosi sɛ wɔbɛhwɛ sɛnea aniwa no mu abubu a ɛwɔ sinus nkitahodi anaa mframa a ɛtwa ho hyia (pneumo-orbit) mu na wɔayi afi hɔ (mpɛn pii no adapɛn 1 kosi 2 ma aguadidan mu wimhyɛn ahorow sɛ retrobulbar mframa wɔ hɔ a, efisɛ mframa a ɛda aniwa no mu no trɛw ɔha biara mu nkyem 25 kosi 30 wɔ wimhyɛn no mu sorokɔ sɛnea Boyle Mmara kyerɛ no, a ɛhyɛ no den aniwa ntini no). Wɔabara asuguare koraa kosi sɛ nnompe bɛsa koraa (adapɛn 4 kosi 8), efisɛ akataso a wɔde piapia ne sinus barotrauma betumi ama mogya a ɛtɔ kɛse wɔ orbital anaasɛ emphysema aba.

Akwankyerɛ ahorow a ɛfa ho¶

• Aniwa mu opira ne ɔhwɛ a egye ntɛmpɛ
• Aniwa ahɔho ade, ani a ɛyɛ mmerɛw, ne welding flash
• Ti a opira ne akisikuru
• Orbital cellulitis, cavernous sinus thrombosis, ne asiane triangle anim nyarewa

Fibea ne aban akwankyerɛ¶

• Amerika Nnuruyɛfo Kuw a Wɔyɛ Oprehyɛn (ACS, United States) Boayikuw a Ɛhwɛ Ahodwiriw So: Advanced Trauma Life Support (ATLS) Asuafo Adesua Nhoma (Aniwa mu Apirakuru ne Emergency Orbital Compartment Syndrome / Lateral Canthotomy ne Cantholysis protocols).
• Amerika Aniwa Ho Adesuabea (AAO, United States): EyeWiki ne Ayaresabea Nsɛm a Ɛfa Orbital Blowout Fractures, Mmofra White-Eyed Trapdoor Fractures, ne Retrobulbar Hemorrhage a Wɔhwɛ So Ho.
• Royal College of Emergency Medicine (RCEM) ne Royal College of Ophthalmologists (RCOphth, United Kingdom): Adeyɛ a Ɛyɛ Paara Akwankyerɛ: Traumatic Orbital Compartment Syndrome ne Emergency Lateral Canthotomy ne Cantholysis.
• Amerika Nnuruyɛfo a Wɔhwɛ Ntɛmntɛm So (ACEP, United States): Ayaresa mu Nneɛma a Wɔyɛ wɔ Nnuruyɛ a Ɛho Hia Ntɛmntɛm mu: Aniwa ne Anim Apirakuru a Wɔde Di Dwuma a Ɛyɛ Den.
• Royal Australian and New Zealand College of Ophthalmologists (RANZCO): Ayaresabea Akwankyerɛ a ɛfa Aniwa mu Apirakuru a Ɛyɛ Hu ne Open Globe Ahobammɔ ho.