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    Nasal & Naso-Orbital-Ethmoid Fracture

    Uploaded by

    Wahyu Julianda
    The document discusses nasal and naso-orbital-ethmoid (NOE) fractures. It notes that nasal fractures are the most common facial bone fractures and often present with symptoms like epistaxis and nasal obstruction. Evaluation involves examination for signs of bone displacement or crepitus and imaging like lateral radiographs. Treatment typically involves surgical reduction and stabilization of the fractured bones. NOE fractures additionally involve the medial orbital wall and require careful evaluation of the soft tissues and buttresses through CT imaging due to the risk of complications like CSF leakage. Surgical approaches usually involve coronal or combined coronal and lower eyelid incisions to access the fracture sites.

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    Nasal & Naso-Orbital-Ethmoid Fracture

    Uploaded by

    Wahyu Julianda
    124 views17 pages
    The document discusses nasal and naso-orbital-ethmoid (NOE) fractures. It notes that nasal fractures are the most common facial bone fractures and often present with symptoms like epistaxis and nasal obstruction. Evaluation involves examination for signs of bone displacement or crepitus and imaging like lateral radiographs. Treatment typically involves surgical reduction and stabilization of the fractured bones. NOE fractures additionally involve the medial orbital wall and require careful evaluation of the soft tissues and buttresses through CT imaging due to the risk of complications like CSF leakage. Surgical approaches usually involve coronal or combined coronal and lower eyelid incisions to access the fracture sites.

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    The document discusses nasal and naso-orbital-ethmoid (NOE) fractures. It notes that nasal fractures are the most common facial bone fractures and often present with symptoms like epistaxis and nasal obstruction. Evaluation involves examination for signs of bone displacement or crepitus and imaging like lateral radiographs. Treatment typically involves surgical reduction and stabilization of the fractured bones. NOE fractures additionally involve the medial orbital wall and require careful evaluation of the soft tissues and buttresses through CT imaging due to the risk of complications like CSF leakage. Surgical approaches usually involve coronal or combined coronal and lower eyelid incisions to access the fracture sites.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    124 views17 pages

    Nasal & Naso-Orbital-Ethmoid Fracture

    Uploaded by

    Wahyu Julianda
    The document discusses nasal and naso-orbital-ethmoid (NOE) fractures. It notes that nasal fractures are the most common facial bone fractures and often present with symptoms like epistaxis and nasal obstruction. Evaluation involves examination for signs of bone displacement or crepitus and imaging like lateral radiographs. Treatment typically involves surgical reduction and stabilization of the fractured bones. NOE fractures additionally involve the medial orbital wall and require careful evaluation of the soft tissues and buttresses through CT imaging due to the risk of complications like CSF leakage. Surgical approaches usually involve coronal or combined coronal and lower eyelid incisions to access the fracture sites.

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    Department of Otorhinolaryngology Head and Neck Surgery

    Faculty of Medicine - Andalas University


    Dr. M. Djamil Hospital, Padang 2014

    Nasal & Naso-Orbital-Ethmoid Fracture

    Chandra - Nur
    Facial Plastic and Reconstructive Surgery SubDivision
    Nasal Fractures
    • Nasal bone fracture are the most commonly
    fracture of all facial bone
    • Male > female
    • The goal of nasal fracture management should
    be to reestablish the preexisting nasal airway
    and cosmetic

    Facial Plastic & Reconstruction Surgery SubDivision


    Nasal Fractures
    Nasal Fractures
    Nasal Fractures
     Symptoms
     Epistaxis
     Rhinorrhea
     Nasal obstruction
     Detailed history exploring mechanism & timing of
    injury, and loss of consciousness help
    distinguish isolated nasal and septal fractures
    from other injuries.

    Bailey B.J, Johnson J.T, Head and Neck Surgery,


    Otolaryngology, Maxillary and Periorbital fracture, 2006
    Facial Plastic & Reconstruction Surgery SubDivision
    Nasal Fractures
    • Sign
     Depression or displacement of nasal bones
     Edema of nose generally limited within the first 2 to 3
    hours after the trauma
     Crepitus and tenderness on palpation
     Fracture of septal cartilage with displacement or mobility
     Septal hematoma
    • Detailed facial examination also important & should include
    visual acuity, extraocular muscle movement, pupil size and
    reactivity, intercanthal distance, medial canthal tendon
    position, mandibular range of motion, and occlusion

    Facial Plastic & Reconstruction Surgery SubDivision


    Nasal Fractures
    All nasal injuries should be
    evaluated for septal
    hematoma

    Untreated abscess, necrosis septal


    and saddle nose deformity

    Bailey B.J, Johnson J.T, Head and Neck Surgery,


    Otolaryngology, Maxillary and Periorbital fracture, 2006
    Facial Plastic & Reconstruction Surgery SubDivision
    Nasal Fractures
    • Radiographs:
    – Lateral projection
    • Treatment:
    – Surgical

    Bailey B.J, Johnson J.T, Head and Neck Surgery,


    Otolaryngology, Maxillary and Periorbital fracture, 2006
    Facial Plastic & Reconstruction Surgery SubDivision
    Nasal Fractures

    Facial Plastic & Reconstruction Surgery SubDivision


    NOE
    • Houses the lacrimal apparatus, medial canthal
    ligament, and anterior ethmoidal artery
    • Assessment of these injuries requires close
    attention to the soft tissue and osseous
    structures and an accompanying CT
    scan(coronal and axial views)

    Facial Plastic & Reconstruction Surgery SubDivision


    NOE
    • Frontomaxillary buttress provides structural
    support to this region and serves stabilization
    point for reconstruction
    • Lateral buttresses are frontal bar superiorly
    and the zygoma and inferior orbital rims
    inferiorly
    • Medial portion of the buttress contains the
    perpendicular plate, lacrimal ones, and lamina
    papyracea

    Facial Plastic & Reconstruction Surgery SubDivision


    NOE
    • Symptom
    – CSF rhinorrhea
    – Epistaxist
    • Sign
    – Telecanthus (>45mm)
    – Diplopia
    – Epiphora
    – Narrowing of the palpebral fissure
    – Periorbital edema
    – Flatting of the base of the naso-
    orbital valley
    NOE type 1(Markowitz)
    • Only one portion of the medial
    orbital rim, with its attached medial
    canthal tendon
    • May uni / bilateral
    • Management:
    • 3 point rigid fixation
    reestablishing the relationships of
    the nasofrontal junction to the nasal
    complex, the nasal complex to the
    maxillary buttress, and the nasal
    complex to the infraorbital rim
    Oral & maxillofacial trauma
    NOE type 2
    • May uni / bilateral
    • Large segment /
    comminuted and
    canthus medial
    attached to large
    central segment
    • Require extensive
    superioinferior
    approach  coronal
    flap and infraorbital and
    intraoral inscision
    Oral & maxillofacial trauma
    NOE type 3
    • Comminution involving
    the central fragment of
    bone where the medial
    canthal tendon attach
    • Require trannasal wiring

    Oral & maxillofacial trauma


    NOE
    • Coronal incision is most
    used in management of
    fracture on the NOE
    region
    • A lower eyelid incision
    may also necessary to
    gain access to the
    inferomedial orbital
    component
    Thank You

    Facial Plastic & Reconstruction Surgery SubDivision

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