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Alamillos FJ, Sanjuan A, Centella I, Dean A. Increased Reliability in Medial Canthal Tendon Reposition in Nasoorbitoethmoidal Fractures with Computer-assisted Surgery and Surgical Navigation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5026. [PMID: 37360236 PMCID: PMC10287121 DOI: 10.1097/gox.0000000000005026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/05/2023] [Indexed: 06/28/2023]
Abstract
Avulsion of the medial canthal tendon secondary to nasoorbitoethmoidal fractures leads to severe aesthetic and functional impairments. The tendon should be repositioned at the posterior lacrimal crest. Owing to the complexity of nasoorbitoethmoidal fractures, accurate location of this point during surgery can be challenging. With the aid of computer-assisted planning and surgical navigation, the point at which the medial canthal tendon should be repositioned can be easily and precisely located. We have developed an innovative navigation-assisted technique that increases the reliability and safety of internal canthus repositioning. We performed a case series of three consecutive patients who underwent medial canthal tendon repositioning using computer-assisted planning and surgical navigation. We believe that this innovation provides a new and useful application of computer-assisted planning and surgical navigation in craniomaxillofacial surgery.
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Affiliation(s)
- Francisco J. Alamillos
- From the Maxillofacial Surgery Department, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Medical School, Córdoba University, Córdoba, Spain
| | - Alba Sanjuan
- Maxillofacial Surgery Department, Charleston Area Medical Center, Charleston, W. Va
| | - Inmaculada Centella
- Maxillofacial Surgery Service, Reina Sofía University Hospital, Córdoba, Spain
| | - Alicia Dean
- From the Maxillofacial Surgery Department, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Medical School, Córdoba University, Córdoba, Spain
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Na Y, Seo C, Kwon Y, Kim J, Choi H, Shin D, Lee M. Treatment of a naso-orbito-ethmoid fracture using open reduction and suspension sutures: a case report. Arch Craniofac Surg 2022; 23:269-273. [PMID: 36596750 PMCID: PMC9816636 DOI: 10.7181/acfs.2022.00983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Naso-orbito-ethmoidal (NOE) fractures are complicated fractures of the mid-face. The treatment of NOE fractures is challenging and a comprehensive treatment strategy is required. We introduce a case of NOE fracture treated with open reduction and suspension sutures. A 28-year-old woman presented with a unilateral NOE fracture. To reduce the frontal process of the maxilla, a suspension suture was made by pulling the fragment using a double arm suture via a transcaruncular incision. The suture thread was placed in the horizontal plane. Another suspension suture on the inferior orbital rim assisted reduction procedure, and they passed through the overlying skin. The reduction alignment could be finely adjusted by tightening the transcutaneous suture threads while checking the degree of bone alignment through the subciliary incision. The two suture threads were suspended using a thermoplastic nasal splint. An additional skin incision on the medial canthal area, which would have resulted in a scar, could be avoided. Four months postoperatively, computed tomography showed an accurate and stable reduction. The patient was satisfied with her aesthetic appearance, and functional deficits were not present.
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Affiliation(s)
- Youngsu Na
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul,
Korea
| | - Chaneol Seo
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul,
Korea
| | | | - Jeenam Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul,
Korea
| | - Hyungon Choi
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul,
Korea
| | - Donghyeok Shin
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul,
Korea
| | - Myungchul Lee
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul,
Korea
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Application of One Piece Autologous Rib Cartilage Graft in Hollow Space of Complete Naso-Ethmoid Orbital Fracture. J Craniofac Surg 2022; 33:1028-1031. [DOI: 10.1097/scs.0000000000008233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Introduction of Digital-Assisted Multidisciplinary Treatment in the Functional and Morphological Reconstruction of Naso-Orbital-Ethmoid Fractures. J Craniofac Surg 2022; 33:1991-1995. [PMID: 35240667 DOI: 10.1097/scs.0000000000008608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study summarizes the process of digital-assisted multidisciplinary treatment (MDT) of naso-orbital-ethmoid (NOE) fractures and evaluates the treatment outcomes. From October 2018 to December 2020, 39 patients with NOE fractures were treated in our department, 21 of whom were diagnosed and treated by a multidisciplinary team. After preoperative multidisciplinary discussions and personalized virtual surgical planning, they received MDT with the assistance of a surgical navigation system. The other 18 patients received traditional single-disciplinary treatment, that is, no preoperative multidisciplinary discussions. Oral and maxillofacial surgeons performed surgical design and digitally-assisted surgery alone. After the operation, treatment outcomes were evaluated in terms of aesthetic appearance and function. The duration of preoperative preparation and postoperative aesthetic outcomes were not significantly different in patients who received single-disciplinary treatment and MDT (P > 0.05). However, postoperative functional outcomes were significantly better in patients who received MDT (P < 0.05). Furthermore, no significant complications were found. Digital-assisted MDT has a high application value in repair and appearance reconstruction, especially restoring functionality after NOE fracture; thus, it should be promoted in clinical practice.
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Pati D, Mishra N, Kar I, Meher B, Samal D, Rath KC. Nasoorbitoethmoid fractures in a tertiary care hospital of eastern India: A prospective study. Natl J Maxillofac Surg 2021; 12:42-49. [PMID: 34188399 PMCID: PMC8191546 DOI: 10.4103/njms.njms_151_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/17/2020] [Accepted: 12/02/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study was to report on the pattern of occurrence of nasoorbitoethmoid (NOE) fractures in Odisha and the various factors that influence their distribution. METHODS The study period was from January 1, 2016 to December 15, 2017. After approval from the Institutional Ethics Committee, all patients diagnosed with naso-orbito-ethmoid fractures reporting to the department of OMFS and Level-1 trauma centers were included in the study. Sociodemographic data along with the etiology and type of fracture were mentioned. Associated injuries to other body parts were noted. Open reduction was possible only in five cases of NOE fractures. The treatment plan including the operative approach and postoperative results was evaluated. RESULTS A total of 1192 patients with facial fracture were seen, of which 52 (4.36%) patients had NOE fractures. Males far outnumbered females in a ratio of 9:1. Thirty-three patients (63.46%) had unilateral NOE fracture, while the rest 19 (36.54%) had bilateral NOE fracture. Sixteen (30.76%) cases were classified as Type I, 35 (67.30%) as Type II, and 1 (1.92%) as Type III. Road traffic accidents were the most common cause of NOE fractures (69%), followed by fall (17%) and assault (10%). The most common neurological injury to be associated with NOE fractures was pneumocephalus (29%), followed by diffuse axonal injury (8%). Telecanthus (100%) was found to be the primary clinical feature in patients of NOE fracture, followed by a depressed nasal bridge (92%). Fracture of the nasal bone was invariably associated with NOE fracture. Complications observed due to untreated NOE fractures included a shortened and retruded nose, shortened palpebral fissures, telecanthus, and enophthalmos. CONCLUSION Contemporary management of NOE complex fractures demands precise diagnosis and immediate surgical management with anatomic reduction and rigid fixation of the involved bone segments. With an improvement in socioeconomic status and increased awareness among maxillofacial surgeons, hopefully, a greater number of NOE fracture patients will avail the benefits of open reduction in future.
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Affiliation(s)
- Debashish Pati
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Niranjan Mishra
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Indubhusan Kar
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Brundabati Meher
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Dipti Samal
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
| | - Krushna Chandra Rath
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
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Daniels JS, Albakry I, Braimah RO, Samara MI, Albalasi RA, Begum F, Al-Kalib MAM. Experience with Airway Management and Sequencing of Repair of Panfacial Fractures: A Single Tertiary Healthcare Appraisal in Najran, Kingdom of Saudi Arabia - A Retrospective Study. Ann Maxillofac Surg 2020; 10:402-408. [PMID: 33708586 PMCID: PMC7943977 DOI: 10.4103/ams.ams_202_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 06/27/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Special cooperation is required among surgeons and anesthetists in airway management during repair of panfacial fractures, due to problems of shared airway and occlusion. Several methods have been proposed for airway management and sequencing of repair of panfacial fractures. The main objective of the current study was to share our experience in the airway management and sequencing of repair of panfacial fractures. Methods: This was a retrospective study of panfacial fractures in the Kingdom of Saudi Arabia from January 2008 to December 2018. Data collected included demographics, type of airway management, sequence of repair (as primary variables), and outcome of surgery (secondary variable), while surgeon and anesthetic expertise are confounders. Data were analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY, USA: IBM Corp). Results were presented as simple frequencies and descriptive statistics. Pearson Chi-square was used to compare categorical variables such as airway management and sequencing of repair with the panfacial fractures. Statistical significance was set at P ≤ 0.05. Results: Overall, 1057 patients sustained different categories of maxillofacial bone fractures with 23 females and 1034 males (M:F of 46:1). A total of 43 male patients out of 1057 patients had panfacial fractures during the study period, giving a prevalence rate of 4.1%. Only the 43 male patients with panfacial fractures were analyzed. All cases were as a result of motor vehicular accident. Six (13.9%) patients had tracheostomy while 37 (86.1%) patients had submental intubation. “Bottom-up” and “outside-in” approach was used in 33 (76.7%) patients, while “top-bottom” and “inside-out” approach was used in 10 (23.3%) patients. Discussion: Submental intubation was the major airway management of panfacial fracture, and “bottom-up” and “outside-in” approach was the main sequence of repair in our series. These approaches have been mentioned in the literature. Conclusion: From our study, victims of pan-facial fractures were found to be exclusively male with MVA as the sole etiological factor. Barring severe head injuries, which may necessitate the use of tracheostomy to sustain breathing over a longer period, submental intubation is extremely reliable as a mode of airway management during surgical treatment of panfacial fractures. The sequencing of repair of panfacial fractures can only be determined according to the case presentation rather than a predetermined one.
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Affiliation(s)
- John Spencer Daniels
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ibrahim Albakry
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ramat Oyebunmi Braimah
- Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia
| | - Mohammed Ismail Samara
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Rabea Arafa Albalasi
- Department Oral and Maxillofacial Surgery, Sharourah General Hospital, Sharourah, Kingdom of Saudi Arabia
| | - Farzana Begum
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
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Secondary Correction of Midface Fractures. Atlas Oral Maxillofac Surg Clin North Am 2020; 29:139-150. [PMID: 33516535 DOI: 10.1016/j.cxom.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Traumatic Telecanthus and Posterior Lacrimal Crest Avulsion in a Six-Year-Old Child. J Craniofac Surg 2019; 30:2224-2226. [DOI: 10.1097/scs.0000000000005922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ha YI, Kim SH, Park ES, Kim YB. Approach for naso-orbito-ethmoidal fracture. Arch Craniofac Surg 2019; 20:219-222. [PMID: 31462011 PMCID: PMC6715548 DOI: 10.7181/acfs.2019.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.
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Affiliation(s)
- Young In Ha
- Department of Plastic and Reconstructive Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sang Hun Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Abstract
The orbit is contained within a complex bony architecture with overlying soft tissue that involves many important anatomical structures. Orbital trauma is a frequent cause of damage to these structures. The authors review the literature on reconstructive techniques focusing on fractures of the orbital rim, orbital roof, orbital floor, medial orbital wall, and naso-orbito-ethmoid complex. A thorough literature review was conducted using PubMed analyzing articles relevant to the subject matter. Various search terms were used to identify articles regarding orbital trauma presentation, diagnosis, management, as well as postoperative complications. Articles were examined by all authors and pertinent information was gleaned for the purpose of generating this review. Orbital trauma can result in a wide variety of complications in form and function. Not all orbital fractures require operative repair. However, bony disruption can cause enophthalmos, hypophthalmos, telecanthus, epiphora, cerebrospinal fluid leaks, orbital hematoma, and even blindness to name a few. Timing of operative repair as well as reconstructive method is dictated by the patient's individual presentation. Successful fracture management requires a detailed understanding of the anatomy and pathophysiology to ensure restoration of the patients' preoperative state. Orbital trauma encompasses a wide variety of mechanisms of injury and resulting fracture patterns. A variety of surgical approaches to the orbit exist as has been discussed allowing the surgeon access to all area of interest. Regardless of the fracture complexity, the principles of atraumatic technique, anatomic reduction, and stable fixation apply in all cases.
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Affiliation(s)
- Kirkland N Lozada
- Department of Otolaryngology Head & Neck Surgery, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Patrick W Cleveland
- Department of Otolaryngology Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jesse E Smith
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Han PS, Kim Y, Herford AS, Inman JC. Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures. Semin Plast Surg 2019; 33:138-142. [PMID: 31037052 DOI: 10.1055/s-0039-1685474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Delayed or improper repair of nasoorbitoethmoid (NOE) fractures can lead to debilitating outcomes including diplopia, epiphora, nasal obstruction, facial asymmetry, and poor cosmesis. As such, NOE fractures should be repaired promptly and properly to prevent these unwanted sequelae. Treating patients with delayed, untreated, or inadequately reduced NOE fractures is challenging due to scarring and contracture. Saddle nose deformity, telecanthus, enophthalmos, nasolacrimal duct obstruction, and soft-tissue scarring are often encountered in the secondary management of NOE fractures and should be addressed in the overall context of reestablishing facial symmetry and function.
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Affiliation(s)
- Peter S Han
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Yohanan Kim
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Alan S Herford
- Department of Oral and Maxillofacial Surgery, Loma Linda University, Loma Linda, California
| | - Jared C Inman
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
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Emergency Treatment of Blast, Shell Fragment and Bullet Injuries to the Central Midface Complex. J Maxillofac Oral Surg 2018; 18:124-130. [PMID: 30728703 DOI: 10.1007/s12663-018-1107-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022] Open
Abstract
Purpose Current ballistics and high-energy explosion possess unnoticed, new and significant biophysics and pathophysiology wounding effects that are unique in comparison with civilian trauma. The primary blast wave effects of compressed air due to explosion lead to tattered and crushed eggshell injuries to the upper central midface (UCM). High-energy shell fragments of various shapes and sizes cause extensive destruction and are different from assault rifle's bullets that cause high energy transfer to the tissue by creating a temporary cavitation. Methods Twenty-one patients with unquantifiable war injuries were selected. The emergency managment of lifesaving facial war injuries starts with life threatening hemorrahge or air compramise. This article describes immediate management of medial canthal tendon (MCT), intercanthal region and severe nasal war injuries. Results The utilized procedure obtained good results compared to the results of cases treated only by applying a classic approach of civilian fractures. Conclusion Treatments of UCM injuries are the most difficult since UCM includes the esthetic, physiologic, and anatomical regions of the face. The proposed technique provides immediate excellent stability for soft tissues, bone, and cartilage and is well tolerated in the long term by both the tissue and the patient. Most of the times, victims are treated with limited resources, deficient subspecialty, massive injuries, during mass casualties, and a single surgeon must have to handle all these within a short period of time. UCM injuries are really concerning since this region is the core of facial esthetic and function.
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Abstract
Traumatic panfacial fracture repair is one of the most complex and challenging reconstructive procedures to perform. Several principles permeate throughout literature regarding the repair of panfacial injuries in a stepwise fashion. The primary goal of management in most of these approaches is to restore the occlusal relationship at the beginning of sequential repair so that other structures can fall into alignment. Through proper positioning of the occlusion and the mandibular-maxillary unit with the skull base, the spatial relationships and stability of midface buttresses and pillars can then be re-established. Here, the authors outline the sequencing of panfacial fracture repair for the restoration of anatomical relationships and the optimization of functional and structural outcomes.
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Affiliation(s)
- Kausar Ali
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Salvatore C Lettieri
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN and Plastic Surgery, Maricopa Integrated Health System, Phoenix, Arizona
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Peltola EM, Mäkelä T, Haapamäki V, Suomalainen A, Leikola J, Koskinen SK, Kortesniemi M, Koivikko MP. CT of facial fracture fixation: an experimental study of artefact reducing methods. Dentomaxillofac Radiol 2016; 46:20160261. [PMID: 27786546 DOI: 10.1259/dmfr.20160261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material. METHODS Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120- and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metal-induced artefacts. RESULTS The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT. CONCLUSIONS CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.
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Affiliation(s)
- Elina M Peltola
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Mäkelä
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Haapamäki
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni Suomalainen
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- 2 Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Seppo K Koskinen
- 3 Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Mika Kortesniemi
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika P Koivikko
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Imaizumi A, Ishida K, Nishizeki O. An extended transcaruncular approach for naso-orbito-ethmoid and Le Fort II fracture repair. J Craniomaxillofac Surg 2016; 44:1922-1928. [PMID: 27769723 DOI: 10.1016/j.jcms.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 08/09/2016] [Accepted: 09/19/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Recent advancements in computed tomography have enabled the diagnosis of naso-orbito-ethmoid (NOE) fractures to be made in much greater detail. Surgical access to the upper nasofrontal buttress in NOE fractures, however, has remained unchanged over the past decades. All approaches to these fractures using skin incisions have individual drawbacks. The transcaruncular approach is free of the drawbacks of the cutaneous approaches. We further extended the transcaruncular approach for the treatment of NOE and Le Fort II fractures. METHODS Eight patients; six with Markowitz's Type I NOE fractures and two with Le Fort II fractures, underwent fracture repair using an extended transcaruncular approach to access the upper nasofrontal buttress. RESULTS In all but one case, which required an additional small skin incision on the glabella, the fracture on the upper nasofrontal buttress was repaired through an extended transcaruncular approach without making any skin incisions. All showed excellent fracture re-alignment on post-surgical CT. Complications happened in three cases; those in two cases were attributed to the extended transcaruncular approach, whereas those in the other were not. CONCLUSIONS The extended transcaruncular approach is a promising alternative to current conventional approaches for NOE and Le Fort II fractures, achieving accurate repair without the need for skin incision.
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Affiliation(s)
- Atsushi Imaizumi
- Department of Plastic Surgery, Prefectural Okinawa Chubu Hospital, Aza Miyazato 281, Uruma City, Okinawa, 904-2243, Japan.
| | - Kunihiro Ishida
- Department of Plastic Surgery, Prefectural Okinawa Chubu Hospital, Aza Miyazato 281, Uruma City, Okinawa, 904-2243, Japan
| | - Osamu Nishizeki
- Department of Plastic and Reconstructive Surgery, Prefectural Nanbu Medical Center/Child Medical Center, Aza Arakawa 118-1, Haebaru Town, Shimajiri County, Okinawa, 901-1193, Japan
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Abstract
IMPORTANCE Frontal sinus and naso-orbital-ethmoid (NOE) fractures are among the most challenging injuries in the treatment of maxillofacial trauma. OBJECTIVE To summarize the current knowledge regarding frontal sinus and NOE fractures and to present some of the more recent, evidence-based literature to support current treatment recommendations. EVIDENCE REVIEW A PubMed search of articles from 1990 through 2013 was performed. Search terms included frontal sinus fracture, NOE fracture, naso-orbito-ethmoid fracture, naso-ethmoid-orbital fracture, and nasoethmoid fracture. FINDINGS Advances in sophisticated imaging and evolution in minimally invasive surgical techniques are introducing more conservative options that may provide better patient outcomes while minimizing the risks and morbidity associated with more traditional treatment approaches. CONCLUSIONS AND RELEVANCE The treatment of frontal sinus and NOE fractures is challenging, given the complex anatomy and associated pattern of injuries. Traditional treatment paradigms are evolving and support the role of more conservative treatment algorithms in selected patients.
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Affiliation(s)
- Sachin S Pawar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - John S Rhee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Abstract
The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patientspecific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. This review focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field.
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Affiliation(s)
- Jun-Jun Wei
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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