s using rigid plate and screw fixation of the facial bones. Bone grafts have been used to replace missing or severely fractured bones. This more aggressive surgical approach has dramatically improved the aesthetic results now obtainable with fewer secondary deformities. More Facial Trauma & Facial Reconstructive Surgery Facts...
Nasoethmoid Orbital SkeletonTrauma to the central midface frequently results in fractures of the nasoethmoid orbital (NOE) skeleton. This complex area consists of a union of bones from the nose, orbits, maxilla, and cranium. These fractures may be the most difficult and challenging of all facial fractures to diagnose and treat. To the inexperienced examiner, NOE fractures may be misdiagnosed as simple nasal fractures, and a high degree of suspicion is necessary to make the diagnosis. These fractures may occur as isolated injuries or as part of more complex (LeFort) facial fractures. Failure to diagnose these injuries or inadequate treatment will result in both functional and cosmetic deformities that are very difficult to correct secondarily.
The best results of the NOE fracture are obtained with early diagnosis and aggressive surgical treatment. Complications result when this injury has been misdiagnosed or inadequately treated. Successful surgical treatment of these complex injuries consist of early open reduction and stabilization of bone fragments. Bone grafts are used to restore contour and support to areas of severely fractured or missing bone. Unstable or displaced fractures that are left untreated result in permanent deformities once healed. Late reconstruction is a difficult task that requires repositioning of both bone and soft tissue. Although late reconstruction of these deformities is possible, in general, the best aesthetic results are obtained with definitive repair at the time of injury, avoiding the common pitfalls.
To repair severe fractures around the nasal bone (A), an incision is made into the patient's skin at the top of the head (B). The skin is pulled off the face to expose the fracture (C), which then can be repaired with plates and screws (D). (Illustration by GGS Inc.)
More Facial Trauma & Facial Reconstructive Surgery Facts...
OrbitAn orbital blow-out fracture consists of a fracture of the bones of the eye "socket". This may involve the orbital floor, walls, or roof. Most cases, however, involve the orbital floor. An orbital blow-out fracture is almost always secondary to a blunt blow from a relatively large object, such as a fist, elbow, baseball bat, or sever motor vehicle accident. Most patients will present with pain, tenderness around the eye, swelling, and double vision. Despite this potential for wide variation of internal orbital fractures, there are basic principles that can be applied to aid in diagnosis and treatment. The bony orbits play a vital role in maintaining normal function and aesthetics of the eyes therefore, realignment and reconstruction of the bony orbit of the eye is essential to maintain normal function and appearance of the eyes.
A number of advances have been made in the past 10 to 15 years in the diagnosis and treatment of internal orbital fractures. These advanced techniques have allowed for better exposure of the fractures and better exposure allows fore more precise reduction and stabilization of the fractures. The use of mini- or microplates and metal meshes in combination with bone grafts has also improved stabilization and enhanced the healing of orbital fractures.
Because most of the bone of the internal orbit is thin and weak, it is frequently difficult to reduce and adequately stabilize without the use of autogenous or alloplastic materials.
- Autogenous bone grafts have been the material most often used by craniomaxillofacial surgeons for reconstruction of the internal orbit. Split skll bone has gained popularity because of its low rate of infection and decreased resorption. Other autogenous materials that have been used include bone from the hip (iliac crest) and ribs or from cartilage.
- A variety of alloplastic material such as