Naso-orbito-ethmoid Research Articles

Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures.

Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.

Role of three-dimensional computed tomography in the assessment of nasoorbitoethmoidal fractures.

Successful management of nasoorbitoethmoidal (NOE) fractures requires early diagnosis and accurate determination of the extent of injury. Although the anatomic complexity of the NOE region merits a clear interpretation of the spatial relationships associated with each injury, the role of three-dimensional (3D) computed tomography (CT) in the assessment of these fractures remains unclear. To clarify the diagnostic value of 3D CT, this retrospective analysis compares statistically the accuracy of two-dimensional (2D) CT against 3D CT in the detection of NOE fracture line tracts in 21 consecutive patients with surgically confirmed NOE fractures. Accuracy of radiographic findings of both modalities were compared with intraoperative findings serving as the "gold standard" for detecting fracture lines in NOE fractures. This statistical analysis indicates that combining 3D CT and 2D CT produces a higher diagnostic yield in the evaluation of NOE fractures than using either modality alone. Although 2D CT was significantly superior (p < 0.05) for inspection of the medial orbital wall, 3D CT offered significantly greater diagnostic accuracy (p < 0.05) along the medial maxillary buttress, particularly at the piriform aperture. 3D CT clarified spatially several unusual NOE injuries that were indiscernible with 2D CT alone. We recommend the combination of 3D CT with 2D CT for serious NOE injuries, particularly those involving displacement of the NOE complex or associated with other major midfacial fractures.