Transnasal Stabilization in Naso-orbito-ethmoid Fractures: The Easy Way!

Abstract

Effective management of naso orbito ethmoidal fractures involves both functional and esthetic correction. While functional correction is routinely achieved, in our experience, most secondary deformities resulted from inadequate nasal bridge projection. We hereby suggest a simple technique to stabilize the nasal bridge after mild overcorrection thereby improving the esthetic outcome in naso orbito ethmoidal fractures.

A Naso-Orbito-Ethmoid (NOE) Fracture Associated with Bilateral Anterior and Posterior Frontal Sinus Wall Fractures Caused by a Horse Kick—Case Report and Short Literature Review

“…Despite the fracturing of the posterior frontal sinus wall and the inner cortex of the frontal bone squama, the kick was not sufficiently strong to cause brain laceration, intracranial hemorrhage, cerebrospinal fluid (CSF) leak, or cerebral contusion, lesions that may accompany the fractures located at this level. The patient only had minimal pneumocephalus [1,2,3,4,5,6,7,8,9,10]. The clinical evaluation and the preoperative imaging must determine the pattern of fractures, the status of the medial cantus insertion, the possible leakage of cerebrospinal fluid, and the involvement of the nasolacrimal canal [7,8].…”

“…The treatment of NOE fractures is controversial, difficult, and varies depending on the type of fracture and the associated fracture lines [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Type I NOE fractures are treated by closed methods in the case of fragment stability after reduction, while type II and III fractures or NOE fractures associated with frontal bone fractures require open exposure of the operative field, with direct reduction and osteosynthesis fixation of the fractured fragments, obliteration or cranialization of the frontal sinuses, and in the case of MCT avulsion, the association of intraoperative canthopexy is mandatory [3,7,21,22,23].…”

“…After the NOE complex reduction we did not attempt to perform safety canthopexy because it would have involved the risk of additional lacrimal bone fragmentation as a result of drilling and the subsequent risk of destabilization of MCT insertions [4,6,12,35]. In the contrary case, medial orbital wall reconstruction and canthopexy are required [1,2,3,4,5,6,23]. In terms of sequencing, bone contours will always be reconstructed first [1,2,3,4,5,6,7,8,9,10,11].…”

“…In the contrary case, medial orbital wall reconstruction and canthopexy are required [1,2,3,4,5,6,23]. In terms of sequencing, bone contours will always be reconstructed first [1,2,3,4,5,6,7,8,9,10,11]. This can be achieved using preformed titanium meshes, autologous bone grafts (calvaria, mandible, iliac crest, tibia, etc.)…”

“…A person’s physiognomy is directly dependent on the bone architecture and overlying soft tissues of the midface [1]. Naso-orbito-ethmoid (NOE) fractures alter the shape and projection of the nose, orbital contour, palpebral contour, and implicitly the eye shape, inducing severe functional and cosmetic disorders that practically disfigure the patient [2].…”