Nasoorbitoethmoid fractures in a tertiary care hospital of eastern India

Abstract

Purpose: The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution. Methods: The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated. Results: A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos. Conclusion: Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future.

Pediatric Nasoorbitoethmoid Fractures: A Single Institution’s 15-Year Experience

“…The most common associated injuries across all NOE fracture types were soft tissue injuries, a trend that is also seen in the adult population. 23 Neurologic and ophthalmologic injuries were the next most common associated injuries, respectively, which is also consistent in adults. While we did note that neurologic sequela was common, particularly following high-impact injury mechanisms, for example, motor vehicle accidents, data regarding seatbelt or helmet use and airbag deployment was not consistently recorded in our data.…”

“…The most common associated injuries across all NOE fracture types were soft tissue injuries, a trend that is also seen in the adult population 23 . Neurologic and ophthalmologic injuries were the next most common associated injuries, respectively, which is also consistent in adults.…”

“…Pneumocephalus, which commonly occurs as a result of significant craniofacial trauma, was the most common neurological injury associated with NOE fractures in our patient cohort, a finding which has been reported in adults as well. 23 Overall, rates of adverse outcomes did not differ significantly across NOE types or age groups.…”