Noe complications and treatment
Download
1 / 20

NOE: Complications and Treatment - PowerPoint PPT Presentation


  • 102 Views
  • Uploaded on

NOE: Complications and Treatment. Craniofacial Rounds Thursday May 5, 2011. Anatomic considerations. Medial canthal tendon Bones: frontal, nasal, maxilla, lacrimal, ethmoid Medial orbital wall or orbital floor fractures Anterior cranial fossa

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' NOE: Complications and Treatment' - opa


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Noe complications and treatment

NOE: Complications and Treatment

Craniofacial Rounds

Thursday May 5, 2011


Anatomic considerations
Anatomic considerations

  • Medial canthal tendon

  • Bones: frontal, nasal, maxilla, lacrimal, ethmoid

    • Medial orbital wall or orbital floor fractures

    • Anterior cranial fossa

  • Vessels: Supraorbital, supratrochlear, infratrochlear, anterior and posterior ethmoidal arteries

  • Eye: Globe, optic nerve

  • Lacrimal apparatus

    • Cannaliculi


Diagnosis
Diagnosis

  • CT

  • Old photographs

    • Estimate intercanthal distance


Physical exam
Physical Exam

  • Swelling

  • Intercanthal distance

    • Approx half interpupillary distance

    • >40 mm

  • Eyelid traction

  • Bimanual exam

  • CSF rhinorrhea

  • Eye exam

    • Enophthalmos

    • 20-25% ocular injury


Facial deformity
Facial Deformity

  • Telecanthus

  • Shortened palpebral fissures

  • Enophthalmos

  • Shortened/retruded nose

    • Flattening, collapse, inward telescoping of nasal bones

  • Ocular dystopia


Treatment indications
Treatment Indications

  • All displaced fractures

  • Medial canthal tendon insertion displacement/ disinsertion

    • Telecanthus

  • Facial deformity

  • Nasal airway

  • Tear drainage disruption


Fixation
Fixation

  • Closed reduction, external splinting, wires

    • Indications

      • Simple fractures

    • Pros

      • Simple

    • Cons

      • Cannot correct medial canthal displacement/ disinsertion

      • Unable to reduce medial orbital wall/rim

      • Collapse, flattening, telescoping of nose


Fixation1
Fixation

  • Open reduction, internal fixation

    • Mustarde 1964, Dingman 1964

  • Medial canthal tendon insertion

    • Stranc 1970

    • Canthopexy

      • Suture/wire


Approaches
Approaches

  • Approaches

    • Existing lacerations

    • Local incisions

      • Midline vertical (Stranc)

      • Open sky (Converse 1970)

      • W incision

    • Coronal incision

    • Lower lid incision

    • Upper gingivobuccal sulcus incision


Repair
Repair

  • Bony rim exposure

  • MCT insertion exposure

  • Reduction medial orbital rim

  • Reconstruction medial orbital wall

  • MCT canthopexy

  • Septal reduction

  • Nasal dorsum augmentation

  • Soft Tissue Readaption From Ellis JOMFS 1993


1 bony rim exposure
1. Bony Rim Exposure

  • Exposure

    • Orbital rims

    • Medial orbital wall

      • Anterior ethmoidal arteries – cauterize

      • Posterior ethmoidal arteries – optic nerve just a few mm posterior!!

    • Nasal bridge

      • Careful not to detach MCT insertion

    • MCT

      • ID fragment of insertion



3 reduction medial orbital rim
3. Reduction Medial Orbital Rim

  • Reduce/recon medial orbital rim

    • Transnasal reduction of MCT-bearing bone fragment

    • Simple


  • Transnasal wiring

    • A: Coronal view, horizontal mattress

    • B: Improper placement (too anterior, lateral displacement)

    • C: Proper placement

      From Ellis JOMFS 1993


4 reconstruction medial orbital wall
4. Reconstruction Medial Orbital Wall

  • Alloplastic

    • Titanium mesh, medpor

  • Autologous

    • Bone (rib, calvarium



6 septal reduction
6. Septal Reduction

  • Asch forceps


7 nasal dorsum augmentation
7. Nasal Dorsum Augmentation

Dorsal nasal support to prevent secondary deformities

  • Primary bone grafting

    • Indicated with a severely comminuted septum

    • Risks dorsal support weakness


8 soft tissue readaption
8. Soft Tissue Readaption

  • Recreate the naso-orbital “valley”

  • Stents or bolsters

  • Transnasal wiring for comminuted/severe cases


Conclusion
Conclusion

  • NOE – complex anatomy

  • Secondary deformities difficult to treat

    • Early repair, ORIF

  • Restoration of intercanthal width

    • Proper reduction of canthal tendon bearing fragment

  • Early bone grafting to prevent secondary deformity


ad