Approach for naso-orbito-ethmoidal fracture

Abstract

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

Fraturas Do Complexo Fronto Naso Órbito Etmoidal: Diagnóstico, Tratamento E Suas Correlações Clínicas

“…Deve-se ter a exposição adequada à região fronto-naso-órbito-etmoidal, e então avance lateralmente para expor o processo frontal do osso zigomático e arco zigomático, no qual a camada externa da fáscia temporal profunda e a fáscia superficial do músculo temporal são incluídas no retalho juntamente do ramo temporal do nervo facial (VII par), em um ponto aproximadamente a 2 cm superiormente ao arco zigomático (RAJMOHAN et al, 2015;PISANO & TIWA-NA, 2019;HA et al, 2019). Após a finalização do ato cirurgico, seguimos suturando todos os planos que foram seciconados e suturamos corretamente o acesso coroal (Figura 8.35), buscando uma harmonia integra entre todos os bordos a fim de evitar infecções, ceromas e deiscência.…”

Post-traumatic Telecanthus Induced by a Missed Diagnosis of Avulsion Fracture of the Medial Canthal Tendon

“…2 It is well known that naso-orbitoethmoid (NOE) fractures of type 2 and 3 can cause telecanthus due to the disruption of the MCT insertion. 3,4 However, posttraumatic telecanthus also occurs in traumas without midface fractures and seem to be less severe. Disruption of the MCT insertion due to soft tissue injury of the medial canthus by shearing force or an isolated fracture in the lacrimal crest may be sufficient to evoke telecanthus.…”

“…Post-traumatic telecanthus commonly occurs when the injured MCT is detached from the lacrimal crest owing to poor treatment during the initial trauma 2. It is well known that naso-orbito-ethmoid (NOE) fractures of type 2 and 3 can cause telecanthus due to the disruption of the MCT insertion 3,4. However, post-traumatic telecanthus also occurs in traumas without midface fractures and seem to be less severe.…”

Treatment of a naso-orbito-ethmoid fracture using open reduction and suspension sutures: a case report

“…NOE fractures account for 15% of pediatric facial fractures and fewer than 5% of adult facial fractures [ 2 ]. The central feature of NOE fractures is a displacement of the medial orbital rim with the medial canthal tendon (MCT) attached [ 3 ]. Although the severity of their sequelae varies according to the extent of the fracture and injuries of the surrounding structures, NOE fractures can cause severe disfigurement (e.g., flattening of the mid-face, telecanthus, and dystopia) and functional loss (e.g., diplopia and loss of nasal support) [ 1 , 4 ].…”

“…Through accurate and elaborate reduction, good aesthetic and functional outcomes can be obtained. Various approaches have been described to achieve this goal [ 3 ]. The suspension technique was introduced as a useful option for maintaining unstable nasal bones [ 5 ].…”