[Secondary reconstruction of post-fracture deformities in the nasal-orbital ethmoid region].
OBJECTIVE
To study the surgical reconstruction of secondary fracture deformities of the nasal-orbital ethmoid area.


METHODS
Typical bicoronal and subciliary incisions or the adjacent scar incision were employed to expose the fractured area. The flattened nasal bone was narrowed by curved osteotomy along the medial orbital rims and trimed with a bur. 2-3 pieces of cranial outer table were used to reconstruct the nasal framework, which were fixed to the frontal bone with mini-plates. After the medial orbital wall and orbital floor were exposed, the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with autogenous cranial outer table or Medpor. The medial canthal tendons were anchored superior-posteriorly to the lacrimal fossa with transnasal wires.


RESULTS
From December 1996 to December 2001, 34 cases of severe nasal-orbital ethmoid fracture deformities were repaired with this technique. Of them, 12 cases had combined orbital-zygomatic fracture, 4 cases had fontal sinus fracture, 1 case had Le Fort II and 1 case had Le Fort III fracture. All the patients recovered well and their facial appearance improved greatly.


CONCLUSIONS
The key points for surgical reconstruction of the periorbital post-fracture deformities are narrowing the flattened nasal root by curved osteotomy, the nasal framework reconstruction with autogenous bone graft, the orbital wall repair to correct enophthalmos, and most importantly, the medial canthal tendon reduction and canthal plasty.
Zhang
Zhi-yong
ZY
Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100041, China.
Gui
Lai
L
Luo
Jin-chao
JC
Xia
De-lin
DL
Niu
Feng
F
Huang
Lu-ping
LP
D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods; D002921:Cicatrix / Q000601:surgery; D015841:Enophthalmos / Q000601:surgery; D005004:Ethmoid Bone / Q000293:injuries*; D006801:Humans; D009295:Nasal Bone / Q000293:injuries*; D009667:Nose Deformities, Acquired / Q000601:surgery; D009915:Orbit / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010256:Paranasal Sinuses / Q000293:injuries / Q000601:surgery; D011095:Polyethylenes; D019651:Plastic Surgery Procedures; D012887:Skull Fractures / Q000209:etiology / Q000601:surgery*; D013710:Tendons / Q000601:surgery
C084562:Medpor; D011095:Polyethylenes