Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures

Abstract

Delayed or improper repair of nasoorbitoethmoid (NOE) fractures can lead to debilitating outcomes including diplopia, epiphora, nasal obstruction, facial asymmetry, and poor cosmesis. As such, NOE fractures should be repaired promptly and properly to prevent these unwanted sequelae. Treating patients with delayed, untreated, or inadequately reduced NOE fractures is challenging due to scarring and contracture. Saddle nose deformity, telecanthus, enophthalmos, nasolacrimal duct obstruction, and soft-tissue scarring are often encountered in the secondary management of NOE fractures and should be addressed in the overall context of reestablishing facial symmetry and function.

Application of One Piece Autologous Rib Cartilage Graft in Hollow Space of Complete Naso-Ethmoid Orbital Fracture

“…The NOE region is a complicated 3D delicate structure. Many bony structures are related to this region, such as nasal bones and septum, frontal process of the maxilla, ethmoid bone, lamina papyracea, sphenoid bone, and the frontal bone 4 . Because of this specific structure, reconstruction in this region is difficult for craniofacial surgeons.…”

“…Many bony structures are related to this region, such as nasal bones and septum, frontal process of the maxilla, ethmoid bone, lamina papyracea, sphenoid bone, and the frontal bone. 4 Because of this specific structure, reconstruction in this region is difficult for craniofacial surgeons. Usually, facial bone fractures are reconstructed via realignment of bony fragments and fixation using proper materials.…”

Evidence-Based Medicine for Midface/Orbit/Upper Facial Fracture Repair

“…Common complications of NOE fracture fixation include saddle nose deformity, persistent telecanthus, pseudotelecanthus, enophthalmos/diplopia, and epiphora. 25,28 Telecanthus/pseudotelecanthus Persistent telecanthus is arguably the most challenging problem to manage secondarily in NOE fractures. 25,28 Prevention and timely primary surgery are often the best ways to avoid this complication.…”

Nasal and Naso-orbito-ethmoid Fractures

“…5 The medial canthal tendon (MCT) inserts around the lacrimal fossa and acts as a pump for the lacrimal sac. 6 Thus, NOE fractures can result in dysregulation of tear film clearance and resultant epiphora. The MCT tethers the eyelid to the lateral nose, setting the intercanthal distance which can be altered following trauma due to fracture displacement or avulsion of the MCT from its bony insertion.…”

“…9,14,15 Complications Delayed or improperly repaired nasal fractures may result in nasal obstruction, nasal deformity (e.g., asymmetry, saddle nose deformity, among other deformities), olfactory dysfunction, and septal perforation. 6 NOE fractures that are repaired in a delayed fashion or are malreduced may result in persistent enophthalmos, telecanthus, diplopia, nasolacrimal duct obstruction, epiphora, and persistent facial deformity. Fractures associated with CSF leaks bear an elevated risk of intracranial sequelae such as meningitis and encephalitis until the dural tear has healed or is repaired.…”