Pediatric Nasoorbitoethmoid Fractures: Cause, Classification, and Management

Joseph Lopez, J. D. Luck, Muhammad Faateh, Alexandra Macmillan, Robin Yang, Gabriel Siegel, Srinivas M. Susarla, Howard Wang, Arthur J. Nam, Jacqueline Milton, Michael Grant, Richard Redett, Anthony P. Tufaro, Anand R. Kumar, Paul Manson, Amir Dorafshar

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Currently, there is a paucity of information on the presentation and proper management of pediatric nasoorbitoethmoid fractures. The purpose of this study was to examine the incidence, cause, associated injuries, and management of these fractures. Furthermore, the authors sought to assess outcomes after transnasal wiring or suture canthopexy for type III nasoorbitoethmoid fractures. METHODS: A retrospective cohort review was performed of all patients with nasoorbitoethmoid fractures who presented to a Level I trauma center from 1990 to 2010. Charts and computed tomographic imaging were reviewed, and nasoorbitoethmoid fractures were labeled based on the Markowitz-Manson classification system. Patient fracture patterns, demographics, characteristics, and outcomes were recorded. Univariate and multivariate methods were used to compare groups. RESULTS: A total of 63 pediatric patients were identified in the study period. The sample's mean age was 8.78 ± 4.08 years, and 28.6 percent were girls. The sample included 18 type I injuries, 28 type II injuries, and 17 type III injuries. No significant demographic differences were found between patients with type I, II, and III fractures (p > 0.05). Operative intervention was pursued in 16.7, 46.4, and 82.4 percent of type I, II, and III nasoorbitoethmoid fractures, respectively. In patients with type III nasoorbitoethmoid fractures, no patients with transnasal wiring developed telecanthus. CONCLUSIONS: Pediatric nasoorbitoethmoid fractures are uncommon injuries. Type I fracture can often be treated with close observation. However, type II and III injury patterns should be evaluated for operative intervention. Transnasal wiring is an effective method to prevent traumatic telecanthus deformity in type III fracture patterns.

Original languageEnglish (US)
Pages (from-to)211-222
Number of pages12
JournalPlastic and Reconstructive Surgery
Volume143
Issue number1
DOIs
StatePublished - Jan 1 2019

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Pediatrics
Wounds and Injuries
Demography
Trauma Centers
Sutures
Observation
Incidence
Telecanthus

ASJC Scopus subject areas

  • Surgery

Cite this

Lopez, J., Luck, J. D., Faateh, M., Macmillan, A., Yang, R., Siegel, G., ... Dorafshar, A. (2019). Pediatric Nasoorbitoethmoid Fractures: Cause, Classification, and Management. Plastic and Reconstructive Surgery, 143(1), 211-222. https://doi.org/10.1097/PRS.0000000000005106

Pediatric Nasoorbitoethmoid Fractures : Cause, Classification, and Management. / Lopez, Joseph; Luck, J. D.; Faateh, Muhammad; Macmillan, Alexandra; Yang, Robin; Siegel, Gabriel; Susarla, Srinivas M.; Wang, Howard; Nam, Arthur J.; Milton, Jacqueline; Grant, Michael; Redett, Richard; Tufaro, Anthony P.; Kumar, Anand R.; Manson, Paul; Dorafshar, Amir.

In: Plastic and Reconstructive Surgery, Vol. 143, No. 1, 01.01.2019, p. 211-222.

Research output: Contribution to journalArticle

Lopez, J, Luck, JD, Faateh, M, Macmillan, A, Yang, R, Siegel, G, Susarla, SM, Wang, H, Nam, AJ, Milton, J, Grant, M, Redett, R, Tufaro, AP, Kumar, AR, Manson, P & Dorafshar, A 2019, 'Pediatric Nasoorbitoethmoid Fractures: Cause, Classification, and Management', Plastic and Reconstructive Surgery, vol. 143, no. 1, pp. 211-222. https://doi.org/10.1097/PRS.0000000000005106
Lopez, Joseph ; Luck, J. D. ; Faateh, Muhammad ; Macmillan, Alexandra ; Yang, Robin ; Siegel, Gabriel ; Susarla, Srinivas M. ; Wang, Howard ; Nam, Arthur J. ; Milton, Jacqueline ; Grant, Michael ; Redett, Richard ; Tufaro, Anthony P. ; Kumar, Anand R. ; Manson, Paul ; Dorafshar, Amir. / Pediatric Nasoorbitoethmoid Fractures : Cause, Classification, and Management. In: Plastic and Reconstructive Surgery. 2019 ; Vol. 143, No. 1. pp. 211-222.
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AU - Lopez, Joseph

AU - Luck, J. D.

AU - Faateh, Muhammad

AU - Macmillan, Alexandra

AU - Yang, Robin

AU - Siegel, Gabriel

AU - Susarla, Srinivas M.

AU - Wang, Howard

AU - Nam, Arthur J.

AU - Milton, Jacqueline

AU - Grant, Michael

AU - Redett, Richard

AU - Tufaro, Anthony P.

AU - Kumar, Anand R.

AU - Manson, Paul

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N2 - BACKGROUND: Currently, there is a paucity of information on the presentation and proper management of pediatric nasoorbitoethmoid fractures. The purpose of this study was to examine the incidence, cause, associated injuries, and management of these fractures. Furthermore, the authors sought to assess outcomes after transnasal wiring or suture canthopexy for type III nasoorbitoethmoid fractures. METHODS: A retrospective cohort review was performed of all patients with nasoorbitoethmoid fractures who presented to a Level I trauma center from 1990 to 2010. Charts and computed tomographic imaging were reviewed, and nasoorbitoethmoid fractures were labeled based on the Markowitz-Manson classification system. Patient fracture patterns, demographics, characteristics, and outcomes were recorded. Univariate and multivariate methods were used to compare groups. RESULTS: A total of 63 pediatric patients were identified in the study period. The sample's mean age was 8.78 ± 4.08 years, and 28.6 percent were girls. The sample included 18 type I injuries, 28 type II injuries, and 17 type III injuries. No significant demographic differences were found between patients with type I, II, and III fractures (p > 0.05). Operative intervention was pursued in 16.7, 46.4, and 82.4 percent of type I, II, and III nasoorbitoethmoid fractures, respectively. In patients with type III nasoorbitoethmoid fractures, no patients with transnasal wiring developed telecanthus. CONCLUSIONS: Pediatric nasoorbitoethmoid fractures are uncommon injuries. Type I fracture can often be treated with close observation. However, type II and III injury patterns should be evaluated for operative intervention. Transnasal wiring is an effective method to prevent traumatic telecanthus deformity in type III fracture patterns.

AB - BACKGROUND: Currently, there is a paucity of information on the presentation and proper management of pediatric nasoorbitoethmoid fractures. The purpose of this study was to examine the incidence, cause, associated injuries, and management of these fractures. Furthermore, the authors sought to assess outcomes after transnasal wiring or suture canthopexy for type III nasoorbitoethmoid fractures. METHODS: A retrospective cohort review was performed of all patients with nasoorbitoethmoid fractures who presented to a Level I trauma center from 1990 to 2010. Charts and computed tomographic imaging were reviewed, and nasoorbitoethmoid fractures were labeled based on the Markowitz-Manson classification system. Patient fracture patterns, demographics, characteristics, and outcomes were recorded. Univariate and multivariate methods were used to compare groups. RESULTS: A total of 63 pediatric patients were identified in the study period. The sample's mean age was 8.78 ± 4.08 years, and 28.6 percent were girls. The sample included 18 type I injuries, 28 type II injuries, and 17 type III injuries. No significant demographic differences were found between patients with type I, II, and III fractures (p > 0.05). Operative intervention was pursued in 16.7, 46.4, and 82.4 percent of type I, II, and III nasoorbitoethmoid fractures, respectively. In patients with type III nasoorbitoethmoid fractures, no patients with transnasal wiring developed telecanthus. CONCLUSIONS: Pediatric nasoorbitoethmoid fractures are uncommon injuries. Type I fracture can often be treated with close observation. However, type II and III injury patterns should be evaluated for operative intervention. Transnasal wiring is an effective method to prevent traumatic telecanthus deformity in type III fracture patterns.

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