Abstract
Incidence of visual disorders induced by head injuries is well known. Such accident may result from optic canal fracture through apex of the orbit, which is caused by slight blow on lateral-upside of the eyebrow. The author believes that it is better to operate on the above-mentioned case at an early stage after shock or unconscious state of the patient has passed. Many surgical operative procedures to treat these cases have been reported; 1) anterolateral craniotomy, 2) extranasal transethmoidal approach, 3) permaxillary transethmoidal method. An intranasal approach was applied in this series. The intranasal transethmo-sphenoidal technique is the most excellent for optic nerve decompression without cosmetic sacrifices. In this paper, the author's Method is shown in detail. A local anesthesia was be used. At the first step of the operation whole ethmoid cells can be cleared away with Griinwald's type of punch-forceps, then the middle turbinate is simply dislocated laterally towards the middle meatus, thus exposing the sphenoid ostium to view. The sphenoid cavity being completely opened, the optic canal becomes visible. In this situation, the method can be devided into two series. When linear or depressed fracture is clearly recognized or prominence of the optic canal is noted, the fractured bony particles should be lifted and then removed. When undefinite and flat prominence of the canal wall is observed, lateral wall of the ethmoid (lamina papyracea) should be removed and compact bony part at the junction between the ethmoid and the sphenoid (so-called apex orbitae) is visualized. With sharp curettes and chisels, the compact bone is resected to find out the optic canal. Immediate improvement of vision will be shown in the patients who were successfully treated in the operation.
