Management of nasoethmoid fractures

Rosenberger, E.; Kriet, J. David; Humphrey, Clinton D.

doi:10.1097/moo.0b013e3283631936

Cited by 30 publications

(35 citation statements)

References 30 publications

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“…General facial edema may show firstly in the early stage of fracture, which will result in distortion of soft tissue landmarks. 2 It might be followed by the symptoms in the eyes and nose. ophthalmic symptoms include diplopia, telecanthus, enophthalmos, epiphora and shortened palpebral fissure, which result from orbit wall or medal canthal tendon malformation.…”

Section: Symptom Of Noe Fracturementioning

confidence: 99%

“…The palpation of nasal dorsum can indicate whether central nasal support structures have been fractured. 2 If intercanthal distance is more than 35mm, a displaced fracture may occur in medial wall and if the distance more than 40 mm, the displaced fracture can be diagnosed. 2 However, in acute phase, the examiner may fail to perform physical examination because of drastic pain, and initial symptoms may cover up real existing characteristics resulting in misdiagnosis.…”

Section: Symptom Of Noe Fracturementioning

confidence: 99%

“…2 Nerve： The NOE region is innervated by ophthalmic and maxillary nerve, which are derived from the trigeminal nerve. 2…”

Section: A N U S C R I P Tmentioning

confidence: 99%

“…Cerebrospinal fluid leak (CSF) may also present, which needs to be highly valued. 2,6 Diagnosis A comprehensive diagnosis should refer to the details about location, extent and displacement of fractures as far as possible, which can be obtained by combination careful physical examination and radiographic imaging. In addition, a pretraumatic photograph can provide additional details.…”

mentioning

confidence: 99%

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The management of naso-orbital-ethmoid (NOE) fractures

Wei

Tang

Liu

et al. 2015

Chinese Journal of Traumatology

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The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patient-specific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. This review focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field.Due to the naso-orbital-ethmoid (NOE) complex's intricate anatomy, the fracture in this region has been one of the most challenging to manage in maxillofacial trauma. The NOE complex is a 3-dimensional delicate anatomic structure. Damage to any structure in this region, even minimal, is quite likely to result in the facial function and appearance abnormal. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTFurthermore, this complex structure has a compact relationship with the brain and eyes, because it separates the nasal, orbital cavities from cranial cavity. Therefore, as long as the fracture of the region is suspected, a thorough physical examination and radiographic assessment, such as 2-dimensional (2D) CT and 3-dimensional (3D) CT, must be performed to assess the type and extent of fracture after achieving the stable vital signs.At present, different types of approaches for exposure have been discussed, such as midfacial degloving and endoscopic approach, as well as management of the NOE fracture, such as bone tissue engineering. However, every procedure has its advantages and disadvantages. According to individual injures, the surgeon should select the patient-specific treatment to restore the normal facial function and appearance. This review will discuss the advancement in the field of NOE fracture management. NOE anatomy Bony structure: the NOE complex consists of the nasal bones, frontal process of the maxilla, nasal process of the frontal bone, lacrimal bone, lamina papyracea, ethmoid bone, sphenoid bone and nasal septum, which separate the nasal, orbital cavities from cranial cavity. 1,2 The medial orbital wall is made up of the lacrimal bone and the lamina papyracea of the ethmoid where blowout fracture is easy to occur (Figure 1). 1 Medial canthal tendon (MCT): MCT is the pivotal soft tissue in NOE area, which supports the canthus, enables proper apposition between the eyelid and the globe, and performs as the lacrimal pump. 2 However, there are many controversies on the anatomy of MCT. The main controversy is on the number of the tendon's limbs. Some scholars referred that it had three limbs: anterior, superior, posterior, 2 some others argued that the superior limb did not exist. 3 Furthermore, some report...

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Section: Symptom Of Noe Fracturementioning

confidence: 99%

Section: Symptom Of Noe Fracturementioning

confidence: 99%

“…2 Nerve： The NOE region is innervated by ophthalmic and maxillary nerve, which are derived from the trigeminal nerve. 2…”

Section: A N U S C R I P Tmentioning

confidence: 99%

mentioning

confidence: 99%

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The management of naso-orbital-ethmoid (NOE) fractures

Wei

Tang

Liu

et al. 2015

Chinese Journal of Traumatology

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“…9 Technological advances in intraoperative CT, better plating systems and new surgical instruments and operative techniques have improved our ability to adequately reduce and fix facial fractures and osteotomies. 10 With decreasing radiation doses, CT is likely to become the primary post-operative imaging modality among such patients.…”

Section: Discussionmentioning

confidence: 99%

CT of facial fracture fixation: an experimental study of artefact reducing methods

Peltola¹,

Mäkelä²,

Haapamäki³

et al. 2017

Dentomaxillofacial Radiology

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Objectives: This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material. Methods: Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120-and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metalinduced artefacts. Results: The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT. Conclusions: CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.

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