naso-orbital ethmoid fractures · naso-orbital ethmoid fractures resident physician: s. ross...
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Naso-Orbital Ethmoid Fractures
Resident Physician: S. Ross Patton, MD
Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS
The University of Texas Medical Branch – UTMB Health
Department of Otolaryngology
Grand Rounds Presentation
November 19, 2014
Series Editor: Francis B. Quinn, Jr., MD, FACS -- Archivist: Melinda Stoner Quinn, MSICS
Objectives
1. Review relevant facial anatomy for NOE fractures
2. Review definition and classification of NOE fractures
3. Review surgical approaches and treatment of NOE fractures
NOE Region
https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM
!/?segment=Midface&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-
Diagnosis/noe.jsp
http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html
Medial Canthal Tendon
http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html
Relationship to Other Important Structures
http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html
Midface Buttress System
Nomenclature
NOE - naso-orbital ethmoid
NEC - naso-ethmoid complex
Naso ethmoid orbital
Naso-orbital ethmoidal
http://www.iihs.org/iktopnews/negative-publicity-about-airbags-obscuring-their-benefit-institute-aihs/news/desdvises-against-disconnecting-airbags-except-in-rare-cases
Mechanism Of Injury
http://www.iihs.org/iihs/news/desktopnews/negative-publicity-about-airbags-obscuring-their-benefit-institute-advises-against-disconnecting-airbags-except-in-rare-cases
Markowitz Type I
https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf
ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp
Markowitz Unilateral Type II
https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf
ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp
Bilateral Type II Fracture
https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf
ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp
https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf
ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp
Markowitz Type III
https://www2.aofoundation.org/wps/portal/!ut/p/c0/
Bowstring Sign Palpation/Instrument
https://www2.aofoundation.org/wps/portal/!ut/p/c0/
http://www.technologybloggers.org/science/is-your-computer-damaging-your-
eyes/
Physical Exam: Epicanthal Folds
Plain Films
http://www.bcm.edu/oto/index.cfm?pmid=15481
Water’s ViewCaldwell View
http://www.bcm.edu/oto/index.cfm?pmid=15481
Axial CT- Finding the lacrimal Fossa
-http://www.ajnr.org/content/22/5/845/F4.expansion.html
-http://www.images.missionforvisionusa.org/anatomy/2005/10/orbit-ct-images.html
Management-Acute Management of Related
Problems: Intracranial trauma
-http://neurosciencenews.com/neurology-children-tbi-concussion-research-263/brain-big-bandaid-public/
Planum Sphenoidale
Superior orbital Fissure
Syndrome
Blindness
Epistaxis
-internal carotid
http://emedicine.medscape.com/article/882627-overview#aw2aab6b3
Layers of the Scalp
AO Surgery. Bicoronal Flap. https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/92/04-Approaches/A70_Coronal-approach.jsp&bone=CMF&segment=Midface&approach=Coronal%20approach&Language=en
https://www2.aofoundation.org/wps/portal/surgery/?contentUrl=%2Fsrg%2F92%2F04-Approaches%2FA30_1-lower-eyelid-
transcutan.jsp&bone=CMF&segment=Midface&showPage=approach&approach=Transcutaneous%20lower-eyelid%20approaches
Additional Incision to approach inferior orbit
General Principles
Which fractures need surgery? ***Almost all- (type I)
Goals of Surgery: Restore pre-injury
appearance/function (if possible)
Other fractures: Treat other fx first
Sources
AO Foundation. “Nasal/NOE”. https://www2.aofoundation.org/
wps/portal/!utc1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN39yBTAyMvLwOLUA93I4MQE6B8JJK8haGF
gYFnqKezn7GTn4GBgQkB3X4e-bmp-
gW5EeUAmUJP3w!!/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwRzFFMTBJREZMVUlRUDEwMDA!/?sho
wPage=diagnosis&bone=CMF&segment=Midface
Kellman RM. Maxillofacial Trauma. Cummings Otolaryngology 5th Edition. Ch 23
Bailey BJ. Nasal Fractures. Head & Neck Surgery- Otolaryngology 4th Edition. Ch 71
Papel ID. Frontal Sinus and Nasoorbitoethmoid Complex Fractures. Facial Plastic and Reconstructive Surgery 2nd
edition.
Donald PJ. Frontal sinus and nasofrontoethmoidal complex fractures. SIPAC. 2002.
Shibuya TY. Chen VY. Oh YS. Naso-orbito-ethmoid fracture management. Operative Techniques in Otolaryngology.
2008;19:140-44.
Naso-orbital ethmoid fractures. Medscape Reference. 2/1/2013. http://emedicine.medscape.com/article/869330-
overview
Nguyen M. Koshy JC. Hollier LH. Pearls of Nasoorbitoethmoid trauma Management. Seminars in Plastic Surgery.
24:4:2010.
Papadopoulos H. Salib NK. Management of Naso-Orbital-Ethmoidal Fractures. Oral Maxillofacial Surg Clin N Am
21(2009) 221-225