Local Approaches for the Reconstruction of Frontal and Naso-Orbito-Ethmoidal (NOE) Fractures: Presentation of a Clinical Case and Literature Review

Abstract

Naso-orbito-ethmoidal (NOE) fractures are considered a challenge in reconstruction, due to the anatomical structures involved, such as the medial canthal ligament and the lacrimal apparatus [1], which leads to a complex functional and aesthetic compromise. For surgical access to the area, the use of the coronal, Lynch-Howarth, glabellar “open sky”, “gull wings” and a combination of the last two are described. However, the severity of the trauma and mainly the neurological compromise of the patient will dictate the choice of the approach that allows functional and comprehensive repair of the affected region. In cases where there is no neurological compromise and it is not necessary to carry out a subcranial approach, the use of local approaches is justified, providing adequate visibility and direct access to the fractured region, allowing an adequate reduction and placement of fixing material. A clinical case of anterior frontal sinus wall fracture and NOE fracture are presented, performing the combination of the gull-wing and open-sky approach, described as butterfly wings, achieving adequate visibility and reconstruction.