Removal of intraorbital foreign body under stereo X-ray

The eyelid is a quadrilateral pyramidal cavity with a thick edge that protects the eyeball. The bone wall of the iliac crest is very thin, and the inner wall of the iliac crest and the bone wall of the iliac crest are only 0.5 to 1 mm thick, so it is easily damaged and infected by the pathogenic bacteria caused by the paranasal sinus. The bottom of the raft is the entrance of the scorpion, which is 34.9 to 36.7 mm long, 38.5 to 39.8 mm wide, 46.9 to 47.9 mm deep, and has a volume of 27.4 to 29.3 ml. However, the eyeball is approximately spherical, with a vertical diameter of 23mm, a horizontal diameter of 23.5mm, and a anteroposterior diameter of 24mm. At first glance, the front part of the scorpion seems to be mostly occupied by the eyeball. In fact, the eyeball only accounts for 1/2.5 of the area of the cornice. There is still a large gap between the wall and the surrounding wall. On the other hand, the ratio of the eyelid to the volume of the eyeball is 4.5:1, indicating that there is still a large gap in the ankle. Therefore, the foreign matter coming from the front can enter the crucible between the eyelid and the eyeball. The most common route of entry is from the iliac crest, followed by the upper or lower jaw, and the least from the outer scorpion. In other words, these foreign objects are from the eyeball into the depths of the eyelids, the eyeballs are not directly damaged, and most retain vision. Of course, there are also a few foreign objects flying at high speed, which can pass through the eyeballs, remain in the sputum, and even enter the skull, forming a sacral skull combined with foreign body injuries. Common foreign objects in the sputum include shrapnel, airbrush bullets, glass, stones, wood chips, bamboo or branches. The main clinical manifestations are headache, eye pain, eyelids and conjunctival edema, and some may have slight eyeballs. These foreign bodies can cause many complications, such as intra-orbital hemorrhage, sputum cellulitis, intraorbital abscess, intragranular granuloma and fistula, so preoperative diagnosis is very important. However, medical history is often not diagnosed and must be examined by X-ray, B-ultrasound, CT or magnetic resonance imaging. CT examination can show the nature and number of foreign bodies, and can also show complication of tibiofibular fracture and craniocerebral injury. The image-enhanced X-ray machine can be used to take foreign objects out of the bright room under X-ray fluoroscopy. The enhanced image brightness is stronger than that of a normal X-ray machine, and the fluoroscopic image can be observed through a camera tube and an electronic path monitor (television screen). In order to understand the spatial position of the foreign body, simply turn the X-ray tube and the surgical field can be fixed. If a two-phase fluoroscopy machine with vertical and horizontal positions is used, surgery is more convenient under stereo fluoroscopy. The X-ray machine with a scanning frequency of 1,250 times/s can clearly distinguish 1.5mm foreign objects, which ensures the aseptic operation of the operation and greatly reduces the blindness of the surgical procedure. Treating diseases: foreign bodies in the eye Indication Stereo X-ray lower jaw foreign body removal is suitable for: 1. A metal foreign body located at the back of the sputum, which is bulky, oppresses the surrounding tissue, and has severe irritation. 2. Non-metallic foreign bodies such as wood chips, bamboo chips, and branches. These foreign bodies can produce irritation symptoms and various complications, such as intra-orbital hemorrhage, sputum cellulitis, purulent abscess, intragranular granuloma and fistula. 3. Intraorbital foreign body with concurrent paranasal sinusitis or cranial injury. Contraindications 1. Only suspected of foreign bodies in the sputum, but no irritating symptoms and obvious signs, there is no correct locator. 2. The foreign body is less than 5mm, the surface is smooth, located at the back of the iliac crest, surrounded by soft tissue, no oppression of the optic nerve or extraocular muscles, no inflammation or other irritating reactions, no surgery. Preoperative preparation 1. Before the operation, you should check whether the eyeball is worn or not, whether there is intra-ball hemorrhage or other tissue damage. 2. Make a qualitative and localized foreign body. If there is a fistula, you can inject iodine contrast agent to help locate. 3. Inject anti-tetanus serum at admission and use antibiotics to prevent infection. Surgical procedure The patient lies supine on the see-through table, and the head pillow filter is equipped with an image enhancement device to adjust the amount of milliamps and voltage. When the X-ray machine is fluoroscopy, the X-ray tube voltage is 70-75kvp, and the current is 3mA. When the image-enhanced X-ray machine is used for fluoroscopy, the voltage is 60-65kvp, and the current is 0.1-0.2mA. When the foreign matter on the TV screen is clear, the foreign object is calibrated with reference to the positive X-ray film. Then, according to the operation procedure of the foreign body removal operation in the sputum, when the foreign body is picked up, the foreign matter is taken out. However, the position is still not very accurate. When it is impossible to grasp, the probe can be inserted into the predicted part, and then double-sided fluoroscopy can be performed to rotate the X-ray tube in the positive or lateral position to obtain a spatial impression. At this time, the operator and the assistant closely cooperated according to the duties. The assistant observes the TV screen and continuously reports the relative position of the device and the foreign object. The operator holds the probe or the sputum and the mosquito clamp, and clamps the foreign object and slowly takes it out. The surgeon should not look up at the fluorescent TV screen to avoid accidental injury to the tissue inside the device. complication 1. Extraocular muscle damage can cause diplopia and strabismus. 2. Optic nerve damage, can affect vision, severe or even no light. 3. Intraocular vascular injury can cause bleeding. 4. When the tissue reaction in the sputum is severe, it can cause short-term eyeball protrusion and conjunctival edema.

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