A Cadaveric Feasibility Study of the Intraorbital Cannula Injections of Hyaluronidase for Initial Salvation of the Ophthalmic Artery Occlusion

作者：Tansatit Tanvaa^*; Apinuntrum Prawit; Phetudom Thavorn

来源：Aesthetic Plastic Surgery, 2015, 39(2): 252-261.

DOI：10.1007/s00266-015-0456-1

• Hyaluronidase injection
• Cosmetic facial injection
• Orbital margins
• Ophthalmic artery

Phthisis bulbi may follow cosmetic filler injections. Early attempts to inject hyaluronidase into the orbit after detection of devastating signs and symptoms may potentially mitigate the complications.
Cannula routes along the orbital walls were studied. Depths of injections were determined in 30 dry skulls. Deep cannula insertions were carefully performed while avoiding exiting the orbit. Forty-six cadaveric orbits with intravascular latex injection were dissected to determine injection techniques, to verify structures at risk along the routes, and to evaluate substance dispersion.
The limited depths of the superior, lateral, medial, and inferior injection routes were 4.2, 3.8, 3.6, and 2.5 cm respectively, while the orbital width was 3.9 cm. The superior parasagittal injection was effective and rarely tears the superior ophthalmic vein, artery, and the optic nerve. The medial injection should be avoided because it may injure the lacrimal sac, the ophthalmic artery, and the optic nerve. Without limited depth, the lateral injection may damage the lacrimal gland and artery and proceeds to damage the optic nerve. The inferior parasagittal injection tends to exit into the infratemporal fossa but the inferior oblique injection may be safer and effective but more complicate with the depth of 4.2 cm.
The superior parasagittal injection is a recommended simple technique with a minimal chance of vascular injury. The inferior oblique injection requires more skill but it may be safer because of the lower position. For safety reasons, depth of each cannula insertion should not exceed the orbital width.
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• 出版日期2015-4