Evaluation of acute management of naso-orbito-ethmoidal fractures

Michael P. Grant, Nicholas T. Iliff, Paul N. Manson

Research output: Contribution to journalReview article

Abstract

Successful treatment of nasoethmiodal orbital (NOE) complex fractures is dependent on a through preoperative history and physical examination, high resolution computed tomography scanning in the axial and coronal planes combined with a sound understanding of the intricate anatomy of the region. Failure to recognize or definitively treat an NOE complex injury can lead to significant functional impairment and cosmetic deformity that are difficult to treat secondarily. An anatomic classification of NOE complex injuries has been developed that is based on the position and degree of comminution of the "central" (medial canthal-bearing) fragment. Fractures of the NOE region may be divided into three groups ranging from nondisplaced single fragment injuries (type IA) to highly comminuted fractures with avulsion of the medial canthal tendon (type III). The anatomic classification will direct the operative plan with as many as three incisions being required with wide subperiosteal dissection to perform an accurate reduction. Crucial to the accurate reduction of these fractures is the management of the medial canthal-bearing fragment, combined with the re-attachment of the tendon in type III fractures. Bolsters are frequently utilized to counteract the sequelae of chronic soft tissue edema. The most common mistake for the less familiar in treating an NOE complex fracture is failure to recognize its presence. For the more experienced, it is performing an incomplete reduction. To achieve an excellent post-operative result both the soft tissue and crainofacial skeletal require reduction.

Original languageEnglish (US)
Pages (from-to)230-239
Number of pages10
JournalOperative Techniques in Plastic and Reconstructive Surgery
Volume8
Issue number4
StatePublished - Dec 1 2002

ASJC Scopus subject areas

  • Otorhinolaryngology

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