Aesthetic Management of the Nasal Component of Naso-Orbital Ethmoid Fractures

Abstract

The authors discuss the nasal component of naso-orbital ethmoid complex injuries and detail the key principles in their algorithm for aesthetic nasal reconstruction.

Pediatric Nasoorbitoethmoid Fractures

“…Restoration of the nasal height and length requires placement of cantilever bone graft. 2,12,13 The literature describes multiple graft materials such as of cranial bone, rib, and rib with a distal cartilage tip. Securing the graft can be accomplished with miniplate fixation to the nasofrontal area, and internal splinting can further assist in holding nasal fractures in reduction.…”

“…2,11Y13 Nasoorbitethmoid fracture collapses the ethmoid, disrupts the septum, and blunts the nasal dorsum, with shortening of the overall length from the impaction. 2 Clinical examination demonstrates telescoping of both the nasal dorsum and the nasal tip into the piriform with gentle pressure. 2,13,14 Injury to the piriform aperture widens the lateral nasal walls and blunts the lateral maxillary support of the nose.…”

“…2 Clinical examination demonstrates telescoping of both the nasal dorsum and the nasal tip into the piriform with gentle pressure. 2,13,14 Injury to the piriform aperture widens the lateral nasal walls and blunts the lateral maxillary support of the nose. Disruption of the nasal bones, upper lateral nasal cartilages, and lower lateral cartilages worsens the collapse of the nasal structure.…”

Complicaciones en pacientes operados de reducción de fracturas naso-órbito-etmoidales de acuerdo con la clasificación de Manson y Markowitz

“…21,22 Una de las complicaciones más comunes derivadas de las fracturas NOE es el telecanto traumático, con una incidencia tan alta como del 70%, según lo reportado por Cruse, 21 en 1990 y Merk, 22 en 1995, en sus respectivos estudios retrospectivos, debido a la lesión y avulsión del ligamento cantal medial. 17,23 Markowitz y su equipo, en su artículo sobre el manejo del tendón cantal medial en fracturas NOE, encontraron que sólo el 3% de los pacientes que sufrieron fracturas NOE con lesiones contundentes tuvieron desplazamiento cantal del tendón. 12 Otros estudios han mostrado mayores proporciones de desplazamiento cantal, pero éstas pueden estar relacionadas con la disección quirúrgica y no con la lesión.…”

Titanium Mini-Plate for Securing Septal Cartilage – A Case of High-Impact Nasal Trauma

“…1,2 Principles of managing nasoethmoid fractures include the restoration of the nasal height, length, tip projection, dorsal projection and septal reconstruction. 3 Where structural deformity following trauma is not addressed, up to 50% of patients following trauma will require revision rhinoplasty or septorhinoplasty. 4 Restoration of dorsal nasal and tip projection, and nasal length as part of nasoethmoid fracture repair is often achieved by insertion of autologous or artificial graft material to the subcutaneous plane under the dorsal external nose and/or columella.…”