양악수술 후 발생한 반사적 눈물분비의 소실 증례 보고 및 문헌 고찰
Loss of Reflex Tearing after Maxillary Orthognathic Surgery Case Report and Literature Review
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목적: 양악수술 후 편측의 반사적 눈물분비의 소실을 보이는 환자를 경험하였기에 증례와 함께 발생기전, 해부학적 구조에 대하여 보고하고자 한다. 증례요약: 32세 여자 환자가 3년 전 부정교합으로 양악수술을 받은 후 발생한 좌안의 반사적 눈물분비 소실을 주소로 내원하였다. 안와 전산화단층촬영에서 안와 내 특이 소견은 보이지 않았으나, 양악수술로 인한 것으로 보이는 좌측의 날개판(pterygoid plate)의 골절 소견을 보였다. 양안의 눈물막파괴시간은 비슷하였으며 세극등검사에서 양안 각막 모두 특이 소견을 보이지 않았다. 병력과 이학적 검진, 전산화단층촬영 소견을 바탕으로 날개입천장신경절(pterygopalatine ganglion)의 손상에 의한 반사적 눈물분비 소실로 진단하였다. 결론: 양악수술 시 인위적 골절형성에 의한 신경손상으로 반사적인 눈물분비의 소실을 보일 수 있으므로 술 전 기본적인 눈물분비와 눈물흘림 반사를 평가해 두는 것이 좋겠다. 신경손상에 의한 반사적 눈물분비의 소실이 초래된 경우 진단을 위해 안와 전산화단층촬영이 필요하며, 안과의사로서 이러한 반사적 눈물분비 소실의 발생기전, 주위 해부학적 구조에 대하여 숙지하여야 하겠다.
Abstract
Purpose: To report a case of unilateral loss of reflex tearing after double-jaw surgery with anatomy and mechanism. Case summary: A 32-year-old woman complained of a 3-year history of loss of tearing in her left eye. She had undergone double- jaw surgery 3 years prior to correct her malocclusion. In orbital computed tomography (CT) images, there were no specific findings, with the exception of a fractured left pterygoid plate, possibly caused by the double-jaw surgery. The tear break-up times of both eyes were similar, with non-specific findings on slit lamp examination. We diagnosed loss of reflex tearing due to pterygopalatine ganglion injury based on her history, physical examination and orbital CT findings. Conclusions: Nerve damage due to artificial fracture may occur during double-jaw surgery and may result in loss of reflex tearing, thus, pre-operative evaluation of basic lacrimal secretion and a reflex tearing test are important. Once the loss of reflex tearing due to nerve injury occurrs, orbital CT scans are needed for diagnosis. Ophthalmologist examination is necessary to confirm the mechanism of loss of reflex tearing and changes in the anatomical structure.
참고문헌 (15)
- Buchanan EP, "LeFort I osteotomy", Semin Plast Surg, 27, pp.149~154 (2013)
- Lanigan DT, "Major vascular complications of orthognathic surgery : hemorrhage associated with Le Fort I osteotomies", J Oral Maxillofac Surg, 48, pp.561~573 (1990)
- 김소미, "Partial Necrosis of the Mandibular Proximal Segment Following Transoral Vertical Ramus Osteotomy", Maxillofacial Plastic Reconstructive Surgery, 36(3), pp.131~134 (2014), 대한악안면성형재건외과학회[DOI]
- Lanigan DT, "Ophthalmic complications associated with orthognathic surgery", J Oral Maxillofac Surg, 51, pp.480~494 (1993)
- Tomasetti BJ, "Lack of tearing after Le Fort I osteotomy", J Oral Surg, 34, pp.1095~1097 (1976)
- Ord RA, "Post-operative retrobulbar haemorrhage and blindness complicating trauma surgery", Br J Oral Surg, 19, pp.202~207 (1981)
- Agbaje JO, "Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances", Int J Oral Maxillofac Surg, 44, pp.447~451 (2015)
- Kang S, "Loss of reflex tearing after maxillary orthognathic surgery : a report of two cases", BMC Ophthalmol, 14, pp.37~ (2014)
- Koizumi K, "Induced modulation in autonomic efferent neuron activity", Am J Physiol, 205, pp.738~744 (1963)
- Langley JN, "On the local paralysis of the peripheral ganglia and on the connection of different classes of nerve fibres with them", Proc R Soc Lond, 46, pp.423~431 (1890)
- Shoshani Y, "Nasolacrimal duct injury after Le Fort I osteotomy", J Oral Maxillofac Surg, 52, pp.406~407 (1994)
- Jang SY, "Nasolacrimal duct obstruction after maxillary orthognathic surgery", J Oral Maxillofac Surg, 71, pp.1085~1098 (2013)
- Kim JW, "Cranial nerve injury after Le Fort I osteotomy", Int J Oral Maxillofac Surg, 40, pp.327~329 (2011)
- Chrcanovic BR, "Optic, oculomotor, abducens, and facial nerve palsies after combined maxillary and mandibular osteotomy:case report", J Oral Maxillofac Surg, 69, pp.e234~241 (2011)
- Cruz AA, "Blindness after Le Fort I osteotomy : a possible complication associated with pterygomaxillary separation", J Craniomaxillofac Surg, 34, pp.210~216 (2006)