Early definitive surgical treatment of severe naso-orbital-ethmoid fractures_2886

By Martha Robinson,2014-10-30 16:06
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Early definitive surgical treatment of severe naso-orbital-ethmoid fractures_2886

Early definitive surgical treatment of severe naso-orbital-

    ethmoid fractures

     Abstract Objective: To evaluate the treatment of early definitive surgery nasal orbital-ethmoid (naso orbital

    ethmoid, NOE) fractures. Methods: 23 patients with severe

    naso-orbital-ethmoid fractures of emergency patients,

    according to body condition, fracture site, deformity surgery in order to determine characteristics, mode of operation combination, OK naso-orbital-ethmoid fractures, rigid fixation

    with mini-titanium plate, inner canthal ligament suspension hanging and so on, to restore facial frame, appearance and function. Results: 23 patients face, mouth opening and biting jaw relations were restored or returned to normal, smaller inner canthal distance, inner canthal level of the sagittal nose height increases, three cases of depression did not improve the eye, diplopia disappeared. Conclusion: The severe naso-orbital-ethmoid fractures in patients with early

    implementation of definitive surgery.

     Key words naso-orbital ethmoid rigid internal fixation

     [ABSTRACT] Objective: To explore the clinical effect of early definitive surgery for naso orbital ethmoid

    fractures. Methods: Ddefinitive surgeries in early stage such as reduction of the fracture, rigid internal fixation (RIF), reconstruction, reattachment of the medial canthal ligament were performed on 23 cases of naso orbital ethmoid

    fractures based on the conditions of physical examination, fracture and malformation. Results: In the 23 cases, the

    complexions, occlusive relation and open reduction were resumed or nearly resumed. Conclusion: Early definitive surgery is a reliable and effective technique for naso

    orbital ethmoid fractures patients.

     [KEY WORDS] Naso orbital ethmoid; Rigid internal

    fixation naso-orbital-ethmoid (naso orbital ethmoid,

    NOE) refers specifically to the middle from both sides of the supraorbital foramen surface composition between the rectangular area [1], is located at the junction of craniofacial , including the nasal bone, maxillary, zygomatic, lacrimal bone, frontal and ethmoid bone, is the human body, one of the most complex anatomical structures. NOE fracture as soon as possible to restore its shape and function, reduce the incidence of deformity. We are NOE fractures in 23 patients with severe systemic disease in patients with stable conditions in the downstream of early definitive surgery, curative effect satisfaction, report as follows.

     1 Data and methods

     1.1 General information from 1998 to 2006 severe acute naso-orbital-ethmoid fractures of 23 patients, with brain, viscera and other relevant departments are required to injury treatment and to be in a stable condition Across definitive surgery. Male and 18 cases, female 5 cases, 16 53 years old,

    an average of 33 years. 7 cases of maxillary fractures, zygomatic, zygomatic arch fracture in 15 cases, 19 cases of nasal bone fracture, orbital bone fracture in 11 cases. Patients with more than a facial collapse, deformity such as

    performance, 18 cases of nasal collapse, 13 cases of widened inner canthal distance, two cases of diplopia, three cases of eye subsidence did not, three cases of facial numbness, 5 cases of limited mouth opening, three cases of biting jaw relationship poor, 2 cases with cerebrospinal fluid

    rhinorrhea. According to Hopkins classification [2] a total of 35 side, ? categories: Center for bone fractures, 19 sides (54.29%); ? categories: Center for bone fracture segment, but the fracture line outside the area, including canthal ligament 11 sides (31.42% ); ? categories: center bone segment

    fracture, fracture of the medial canthal ligament affected

    area five sides (14.29%).

     1.2 Materials used Xi'an Bang Co., Ltd. production of biological materials of titanium rigid internal fixation Titanium series, mini-titanium plate thickness of 0.6? Mm,

    titanium screw diameter of 1.5? Mm, length 3 7? Mm.

     1.3 treatments are guided minimally invasive facial incision principles, use of intraoral vestibular sulcus incision extraoral small incision, such as the palpebral margin, superciliary arch, ears ago, the nose next to the

    temporal region, the eyes canthal incision, etc., for open wounds to make full use original port. Class ? fracture line

    of fracture reduction and rigid internal fixation, ?, ? type

    fractures fracture reduction, rigid internal fixation and inner canthal ligament suspension. With various forms of micro-titanium stent-line facial reconstruction and rigid

    internal fixation to restore facial form and function.

     2 Results

     After the January review, 22 cases (95.65%) population inside and outside the wound a healing, 1 case (4.35%), two healing. All the patients face, mouth opening and biting jaw relations restored or returned to normal, smaller inner canthal distance, inner canthal level of the sagittal nose height increases, three cases of depression did not improve

    the eye, diplopia disappeared, but the facial numbness is not clear improvement. Reposted elsewhere in the paper for free download http://

     3 Discussion

     In dealing with naso-orbital-ethmoid fractures, should

    adhere to AO / ASIF (Association for the Study of

    international fixation) advocated by anatomic reduction and stable fixation, non-invasive surgery and early functional

    treatment of jaw fractures basic principles. In clinical, we found that for severe naso-orbital-ethmoid fractures, stump as

    soon as possible line of micro-titanium rigid fixation of

    fracture reduction can get a good three-dimensional film

    stability, rare and then shift, and in parts of the bear and fractures the static and dynamic load, the stress transfer to effectively guide and avoid stress shielding, so that in absolute steady state reached I heal. While maintaining the

    local blood supply, save the periosteum is also conducive to early healing of bone, so as to achieve satisfactory appearance and function of recovery, is particularly suited to be associated with bone defects and bone repair in patients

    over the same period [3]. Clinical fracture healing of delayed union or non-volatile and more from the retention caused by

poor blood circulation, two-dimensional instability and poor

    blood circulation will fracture healing delay, three-

    dimensional instability and ischemia have resulted in nonunion. Therefore, fracture fixation, when both have a good dimensional stability, but also consider the stress transfer, which is a prerequisite for bone remodeling later.

     Treatment of NOE fracture fracture of the core issue is

    reset, restore inner canthal distance and nose shape [4], to restore the stent surface, try to seek an orthopedic suture, because the availability of soft tissue is extremely limited, to tissue defect is too large may use of flaps, but should be

    minimized with the "Z"-type "W" flap, to prevent the impact of facial scars and even lead to dysfunction, nose, ears and other parts should be noted that alignment suture, defects may be shaping the same period, the wounds sutured using minimally

    invasive , and pay attention to maintaining the edge of lysis, generally do not lock suture.


     [1] Marciani RD. Management of midface fractures: Fifty years later [J]. Oral Maxillofac Surg, 1993, 51:960 968.

     [2] Markowitz BL, Manson PN, Sargent L, et al. Management of the medial canthal tendon in naso ethmoid orbital

    fractures: the importance of the central fragment in classification and treatment [J]. Plast Reconstr Surg, 1991, 87 ( 5): 843 853.

     [3] Frodel JI, Marentette LJ. The coronal approach: anatomic and technical considerations and morbidity [J]. Arch Otolar Neck Surg, 1993, 119:201 207.

     [4] Zhang Yi, Jin-Gang, Sun Yonggang, et al. Nose - orbital

    bone - ethmoid bone fractures [J]. Chinese Journal of Oral

Medicine, 2005,40 (6): 471 473. Reposted elsewhere on the

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