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Treatment of a naso-orbito-ethmoid fracture using open reduction and suspension sutures: a case report

  • Youngsu, Na (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Chaneol, Seo (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Yongseok, Kwon (JJ Plastic Surgery Clinic) ;
  • Jeenam, Kim (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Hyungon, Choi (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Donghyeok, Shin (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Myungchul, Lee (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine)
  • Received : 2022.10.23
  • Accepted : 2022.12.19
  • Published : 2022.12.20

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.

Keywords

References

  1. Buchanan EP, Hopper RA, Suver DW, Hayes AG, Gruss JS, Birgfeld CB. Zygomaticomaxillary complex fractures and their association with naso-orbito-ethmoid fractures: a 5-year review. Plast Reconstr Surg 2012;130:1296-304. https://doi.org/10.1097/PRS.0b013e31826d1643
  2. Kelley P, Crawford M, Higuera S, Hollier LH. Two hundred ninety-four consecutive facial fractures in an urban trauma center: lessons learned. Plast Reconstr Surg 2005;116:42e-49e. https://doi.org/10.1097/01.prs.0000177687.83247.27
  3. Ha YI, Kim SH, Park ES, Kim YB. Approach for naso-orbitoethmoidal fracture. Arch Craniofac Surg 2019;20:219-22. https://doi.org/10.7181/acfs.2019.00255
  4. Nguyen M, Koshy JC, Hollier LH Jr. Pearls of nasoorbitoethmoid trauma management. Semin Plast Surg 2010;24:383-8. https://doi.org/10.1055/s-0030-1269767
  5. Hunter BG, Tasman AJ. Suspension technique for unstable nasal bones. JAMA Facial Plast Surg 2019;21:460.
  6. Roden KS, Tong W, Surrusco M, Shockley WW, Van Aalst JA, Hultman CS. Changing characteristics of facial fractures treated at a regional, level 1 trauma center, from 2005 to 2010: an assessment of patient demographics, referral patterns, etiology of injury, anatomic location, and clinical outcomes. Ann Plast Surg 2012;68:461-6.
  7. Garg RK, Alsheik NH, Afifi AM, Gentry LR. Pterygoid plate fractures: not limited to Le Fort fractures. J Craniofac Surg 2015; 26:1823-5. https://doi.org/10.1097/SCS.0000000000001901
  8. Fraioli RE, Branstetter BF 4th, Deleyiannis FW. Facial fractures: beyond Le Fort. Otolaryngol Clin North Am 2008;41:51-76. https://doi.org/10.1016/j.otc.2007.10.003
  9. Gruss JS, Hurwitz JJ, Nik NA, Kassel EE. The pattern and incidence of nasolacrimal injury in naso-orbital-ethmoid fractures: the role of delayed assessment and dacryocystorhinostomy. Br J Plast Surg 1985;38:116-21. https://doi.org/10.1016/0007-1226(85)90098-0
  10. Rosenberger E, Kriet JD, Humphrey C. Management of nasoethmoid fractures. Curr Opin Otolaryngol Head Neck Surg 2013;21:410-6. https://doi.org/10.1097/MOO.0b013e3283631936
  11. Doerr TD. Evidence-based facial fracture management. Facial Plast Surg Clin North Am 2015;23:335-45. https://doi.org/10.1016/j.fsc.2015.04.006
  12. Cultrara A, Turk JB, Har-El G. Midfacial degloving approach for repair of naso-orbital-ethmoid and midfacial fractures. Arch Facial Plast Surg 2004;6:133-5. https://doi.org/10.1001/archfaci.6.2.133
  13. Converse JM, Hogan VM. Open-sky approach for reduction of naso-orbital fractures: case report. Plast Reconstr Surg 1970;46: 396-8. https://doi.org/10.1097/00006534-197010000-00017
  14. Hwang K, Joong Kim D. Reduction of supraorbital fractures via a short sub-brow incision. J Craniofac Surg 2018;29:2164-5. https://doi.org/10.1097/scs.0000000000004738
  15. Jung JS, Kang DH, Lim NK, Kim H. Orbital wall restoration with primary bone fragments in complex orbital fractures: a preliminary study. Arch Craniofac Surg 2020;21:156-60. https://doi.org/10.7181/acfs.2020.00101
  16. Kim T, Kim BK. Endoscopic slide-in orbital wall reconstruction for isolated medial blowout fractures. Arch Craniofac Surg 2020;21:345-50. https://doi.org/10.7181/acfs.2020.00605
  17. Kim YJ, Kim JH, Kim YS, Cheon YW. Pin-site scar revision with subcisions and acellular dermal matrix. Arch Aesthetic Plast Surg 2020;26:38-40. https://doi.org/10.14730/aaps.2019.01935
  18. Kim KT, Sun H, Chung EH. Comparison of complete surgical excision and minimally invasive excision using CO2 laser for removal of epidermal cysts on the face. Arch Craniofac Surg 2019; 20:84-8. https://doi.org/10.7181/acfs.2018.02152
  19. Hur SW, Kim SE, Chung KJ, Lee JH, Kim TG, Kim YH. Combined orbital fractures: surgical strategy of sequential repair. Arch Plast Surg 2015;42:424-30. https://doi.org/10.5999/aps.2015.42.4.424