Primary, definitive treatment of the nasoethmoidorbital-midface-frontobasal injuries in the maxillofacial practice

Abstract

Nasoethmoid-orbital (NEO) fractures are typically resulted by a drastic, forceful blow to the central aspect of the head and nose, associated injuries to adjacent structures occur and involve the midface, anterior cranial fossa and the eye. Dislocated bony parts of the nose may be impacted into the intraorbital region and lead to severe complications: cerebrospinal fluid leak, optic nerve lesion, anosmy, telecanthus and diplopy. In the complex management of the craniofacial lesions, a cooperative team-work of maxillofacial surgeon, neurosurgeon, otolaryngologist and ophthalmologist is required. The key of the surgery treatment is the actual status of the NEO structure. Stabilized nasoethmoidal fragments, midface and the watertight dura closure or plasty are basically important conditions for the ceasing of nasal liquorrhoea. Repositioning of fractured fragments, stabilization with titanium miniplates and reconstruction of bony defect using autologous bone are commonly used techniques at our practice. Between years 1995-2000, altogether 50 cases of injuries due to NEO fracture have been treated at our department of maxillofacial surgery. We report the possible combinations of traumatism, our operative methods, our supply tactics and experiences. Multiple and defect fractures of the craniofacial bones may cause irreversible deformities, chewing and nutritional disturbances. We preferred the early, primary, definitive supply, with the respect of aesthetic viewpoints with the application of streamlined operative methods like bone fixation and bone replacement. Our fundamental aim is the reduction of the patients' operative load, their nursing time and the enhancement of our operative results.