10세 소년의 안와 골막하혈종에서 발생한 신생골 형성
Osteoneogenesis on Subperiosteal Orbital Hematoma in a 10-Year-Old Boy
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목적: 외상 후 안와에 발생한 골막하혈종에서 급격히 골형성이 일어난 증례 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 외상 후 집중치료를 받던 10세 소년에서 우안에 안구돌출 및 안구운동장애를 보이는 골막하혈종 소견이 있었다. 안과검사에서 3 mm 안구돌출과 상측주시 때 우안 안구운동제한이 관찰되었으나 시력저하 소견은 없었다. 1개월 후 안와전산화단층촬영에서 골막하혈종 크기는 다소 감소하였으나 안와와의 경계면에서 신생골 형성 소견을 보였다. 앞측안와절개술을 시행하여 혈종을 제거하고 골조직을 완전절제하였다. 혈종과 안와 사이의 경계에서 형성된 신생골이 앞쪽 안와연에서 안와첨까지 전두골에 단단하게 붙어있었고, 조직검사에서 미성숙골조직이 관찰되었다. 수술 1년 후 경과관찰에서 우안 안구돌출 및 안구운동장애는 소실되고 새로운 골형성은 보이지 않았다. 결론: 안와 골막하혈종은 대개 심한 신경이상을 초래하지 않으면 자연 흡수되도록 보존적인 치료를 하는 것이 권장되나 본 증례에서와 같이 1개월 내의 짧은 시간에 골형성이 올 수도 있으므로, 집중치료를 받는 환자나 혈종의 흡수가 늦은 환자에 대해서는 주의 깊은 경과 관찰이 필요할 것으로 보인다.
Abstract
Purpose: We report the first case in Korea of rapid bone formation on a subperiosteal orbital hematoma after trauma. Case summary: A 10-year-old boy who was in the intensive care unit after trauma showed proptosis and ocular movement limitation of the right eye associated with subperiosteal hematoma. On ocular examination, 3 mm of proptosis and limitation of right eye movement were observed; however, visual acuity was not decreased. At 1 month after the trauma, orbital computed tomography (CT) showed new bone formation at the margin of the hematoma border although the size of the hematoma decreased. The patient underwent hematoma and bony tissue removal using anterior orbitotomy approach. A new bone was formed between the orbital border and hematoma from the anterior orbital margin to the orbital apex. During pathological examination, woven bone tissue with fibrotic tissue was observed in the hematoma wall. One year after surgery, the patient’s proptosis and limitation of ocular movement disappeared without any evidence of new bone formation. Conclusions: Waiting for spontaneous absorption of orbital subperiosteal hematoma is usually recommended unless there is significant functional impairment. However, as in our case, new bone formation could occur during a short period of less than 1 month; imaging follow-up is necessary in patients having intensive care or showing delayed absorption of a hematoma.
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