Different surgical approaches for nasal-orbit-ethmoidal fractures: two cases report

Abstract

Trauma is defined as damage with or without intention caused to the organism by a sudden exposure to energy sources that exceed its tolerance margin. In turn, facial skull trauma is described as one that affects the dentoalveolar complex, bony structures and soft tissues of the maxillofacial territory.1 The Nasal-Orbit-Ethmoidal Complex fractures cover the middle area of the midfacial third, being extended fractures when they have a bilateral commitment, with a high aesthetic compromise and difficult to handle, thus becoming a great challenge for maxillofacial surgeons.1 The Nasal-Orbit-Ethmoidal complex corresponds to a complex structure formed by the nasal bones, nasal septum, nasal-frontal process, ethmoids, papiraceous laminae of the lacrimal bone and sphenoid, so any alteration of these structures will have important functional and aesthetic consequences.3 Nowadays, there are several ways to approach these fractures, the coronal approach being the most used since it allows a correct access and visibility of the nasal frontal area. Despite this, this approach requires precision and surgical expertise. On the other hand, due to the area of the incision, hair less patients have a considerable aesthetic impact.4 Below are two cases of Nasal-Orbit-Ethmoidal fractures evaluated and treated by the maxillofacial surgery team at the El Carmen Metropolitan Hospital, Santiago, Chile. Both required neurological and ophthalmological evaluation, discarding commitment at that level. The first case corresponds to a patient with an extended fracture of the Nasal-Orbit-Ethmoidal complex in which an approach was made through pre-existing lacerations in the frontal nasal area, complementing it with a transconjunctival approach with extension and lateral canthotomy to access the lateral wall and floor of the right orbit. The second patient corresponds to a patient with a fracture of the frontal component and Nasal-Orbit-Ethmoidal which was approached by means of a coronal incision. Cases