목적 : Medpor를 사용하여 안와골절정복술을 시행한 후 급성으로 발생한 안와농양에 대해 보고하고자 한다. 증례요약 : 주먹에 의한 우안부 수상 후 발생한 복시를 주소로 15세 남자가 내원하였다. 안와전산화단층촬영에서 안와하벽골절이 확인되어 MedporⓇ를 사용한 안와골절정복술을 시행하였다. 술 후 3일간은 증상의 호전을 보였으나 4일째부터 하전안구운동장애, 하안검부종 및 안구돌출 소견을 보였다. 수술 후 8일째 시행한 안와전산화단층촬영에서 MedporⓇ를 포함하고 있는 낭성종괴를 확인할 수 있었고 세침흡인검사에서 염증 소견을 보였다. 전신적 항생제치료를 시작하였으나 호전이 없어 결막절개를 통한 안와접근법으로 농양과 MedporⓇ를 제거하였다. 제거한 MedporⓇ의 배양검사에서 Staphylococcus aureus가 검출되었고 조직에서는 염증세포가 증가된 소견을 보였다. 농양제거술 시행 후 임상증상은 호전되었으나 하전안구운동장애와 복시가 일부 잔존하였다. 결론 : 안와골절정복술 후 수일 내에 안구운동장애, 하안검부종 지속 및 안구돌출 등의 소견을 보일 경우 드물지만 인공삽입물의 감염에 의한 안와농양의 병발 가능성도 염두에 두어 적절한 진단과 조기치료를 시행하는 것이 필요할 것으로 생각된다.

Purpose: To report a case of acute orbital abscess after MedporⓇ implantation for orbital floor fracture repair. Case summary: A 15-year-old boy who was punched in the right orbit visited our clinic because of diplopia. An orbital CT scan demonstrated a fracture of the right orbital floor. At surgery, a Medpor sheet was placed over the orbital floor defect. Over the first three days, clinical improvement was gradual, but at four days postoperatively, depression of the right eye was restricted, and lower lid edema and proptosis was present in the right eye. At eight days postoperatively, the orbital CT scan showed a large cystic mass surrounding the Medpor sheet and fine needle aspiration cytology showed a number of inflammatory cells. Because systemic antibiotics were ineffective, the MedpoⓇ sheet and the cystic mass were removed through a transconjunctival approach to the orbit. A culture of the removed MedporⓇ sheet grew Staphylococcus aureus and signs of inflammatory cells in the tissue were present. After removal of the abscess, most clinical symptoms showed improvement except for the remaining depression of the right eye. Conclusions: Symptoms of eye movement restriction, lower lid edema, and proptosis may be uncommon after orbital floor fracture repair but can occur. We should also consider the possibility of abscess formation due to infection of the implant and emphasize the importance of prompt diagnosis and treatment of such a case.

Purpose: To report a case of acute orbital abscess after MedporⓇ implantation for orbital floor fracture repair. Case summary: A 15-year-old boy who was punched in the right orbit visited our clinic because of diplopia. An orbital CT scan demonstrated a fracture of the right orbital floor. At surgery, a Medpor sheet was placed over the orbital floor defect. Over the first three days, clinical improvement was gradual, but at four days postoperatively, depression of the right eye was restricted, and lower lid edema and proptosis was present in the right eye. At eight days postoperatively, the orbital CT scan showed a large cystic mass surrounding the Medpor sheet and fine needle aspiration cytology showed a number of inflammatory cells. Because systemic antibiotics were ineffective, the MedpoⓇ sheet and the cystic mass were removed through a transconjunctival approach to the orbit. A culture of the removed MedporⓇ sheet grew Staphylococcus aureus and signs of inflammatory cells in the tissue were present. After removal of the abscess, most clinical symptoms showed improvement except for the remaining depression of the right eye. Conclusions: Symptoms of eye movement restriction, lower lid edema, and proptosis may be uncommon after orbital floor fracture repair but can occur. We should also consider the possibility of abscess formation due to infection of the implant and emphasize the importance of prompt diagnosis and treatment of such a case.

Alloplastic implanat, Complication, Orbital abscess, Orbital fracture