Fractures of the nasoethmoidal (NOE) complex constitute one of the more profound challenges in the management of craniofacial trauma. The nasoethmoidal complex serves as a junctional buttress between the nasal bone, medial canthal region of the orbit, anterior skull base, and the frontal bone. Additional clinical considerations include frontal sinus involvement, cerebral spinal fluid (CSF) leak, and integrity of the lacrimal system.
No matter how horrific or how minor the trauma, the basic principles of Advanced Trauma Life Support must be followed. (Otolaryngologists should strongly consider ATLS certification. Some residency programs require ATLS certification at the beginning of the intern year.) Preparation, teamwork, and interdisciplinary communication are essential in obtaining the best patient outcome. As the otolaryngologist, helping secure the airway in an emergent situation is critical. The otolaryngologist must be comfortable with difficult airway scenarios which include following a difficult airway alg
Approaches to the orbit are wide in their variety, abilities and potential complications. With the advent of the endoscopic approach; many previously favored approaches are becoming less common. However; traditional transconjunctival and transcaruncular approaches are the gold standard for large and/or complex fracture patterns. The supraorbital region can also be addressed often via transbleph approaches with favorable cosmetic outcomes.
The midface is a complex anatomical region, with a bony skeletal framework that is composed of a series of vertical and horizontal buttresses. These represent areas of bony thickening which provide a supportive framework for this region. Consequently fractures which involve the buttresses system can destabilize the midface with both functional and aesthetic consequences. As discussed, appropriate management of midfacial trauma requires the utilization of CT imaging, to adequately classify the injury.
Arch bars can be used as definitive treatment of facial fractures or to provide a stable starting point from which to begin open reduction internal fixation. Pediatric fractures and fractures involving the condyle or subcondyle are ideal for definitive treatment with MMF. Placement of MMF arch bars can be tedious, and there are alternative methods of MMF such as IMF screws, but in capable hands it can be a useful surgical tool. It is also necessary to educate patients about the potential complications from MMF placement.
Fractures of the zygoma are the second most common facial injury after nasal fractures. Incidence and demographics will vary depending on the population studied but overall there is a young male predilection which results mostly from motor vehicle accidents or altercations. Due to the prominent location of the zygoma and its proximity to the orbit and mandible, fractures commonly result in functional deficits and almost always will affect cosmesis and facial contour.
