Pearls of Nasoorbitoethmoid Trauma Management

Nguyen, Michelle; Koshy, John C.; Hollier, Larry H.

doi:10.1055/s-0030-1269767

Cited by 41 publications

(55 citation statements)

References 11 publications

(25 reference statements)

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“…25 To prevent further scarring after debulking and all fracture stabilization, a Xeroform or felt bolster should be fashioned and secured with a transnasal suture and left for at least 1 week. 23 In severe fracture cases where bolstering is not possible, we have found external aquaplast nasal splint formation with stabilization using septal or transnasal Kwires (0.7-0.9 mm) and protective K-wire balls can be very helpful to reduce swelling and postoperative fluid collection.…”

Section: Soft-tissue Scarringmentioning

confidence: 93%

“…22 Similarly, failure of adequate external compression in the medial canthal area after bicoronal approaches during the primary repair of NOE fractures can allow blood and fluid to build up underneath the degloved tissue with resultant poor contouring of lateral nasal and infraorbital areas. 23 Posttraumatic fibrosis and subsequent convexity in the tear trough or nasofacial angle region can be surgically thinned to recreate a premorbid, natural concavity. Resuspension of soft tissue can help prevent subsequent soft-tissue ptosis.…”

Section: Soft-tissue Scarringmentioning

confidence: 99%

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Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures

Han

Kim

Herford

et al. 2019

Seminars in Plastic Surgery

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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.

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Section: Soft-tissue Scarringmentioning

confidence: 93%

Section: Soft-tissue Scarringmentioning

confidence: 99%

Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures

Han

Kim

Herford

et al. 2019

Seminars in Plastic Surgery

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“…8 Axial dimension is helpful to follow the ascension of the lacrimal canal whether the medial orbital wall is 'blown out'. 7,8 Coronal dimension is significant insight to provide details of fractures of the middle third of the orbit and the status of the anterior cranial fossa. These sections can assess 'blow-out' fractures of the area where the orbital floor joins the medial wall, which greatly increase orbital volume.…”

Section: Symptom Of Noe Fracturementioning

confidence: 99%

“…Physical examination findings often fail to elucidate the all details of injuries, so the radiographic imaging can provide further more details for the diagnosis and management of NOE fractures. 7,8 Radiographic imaging: In radiographic imaging, the combination 2D computed tomography (CT) and 3D CT has been increasingly popularized. Daniel Remmler's statistical analysis indicated that combining 3D CT and 2D CT could provide more details in the evaluation of NOE fractures.…”

mentioning

confidence: 99%

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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“…Despite the low incidence of NOE fractures, NOE fractures are among the most challenging craniomaxillofacial fractures to treat and inadequate treatment significantly impacts form and function [1,2]. Despite the low incidence of NOE fractures, NOE fractures are among the most challenging craniomaxillofacial fractures to treat and inadequate treatment significantly impacts form and function [1,2].…”

Section: Introductionmentioning

confidence: 99%