title: An extended transcaruncular approach for naso-orbito-ethmoid and Le Fort II fracture repair.
abstract: BACKGROUND
  Recent advancements in computed tomography have enabled the diagnosis of naso-orbito-ethmoid (NOE) fractures to be made in much greater detail. Surgical access to the upper nasofrontal buttress in NOE fractures, however, has remained unchanged over the past decades. All approaches to these fractures using skin incisions have individual drawbacks. The transcaruncular approach is free of the drawbacks of the cutaneous approaches. We further extended the transcaruncular approach for the treatment of NOE and Le Fort II fractures.
  
  
  METHODS
  Eight patients; six with Markowitz's Type I NOE fractures and two with Le Fort II fractures, underwent fracture repair using an extended transcaruncular approach to access the upper nasofrontal buttress.
  
  
  RESULTS
  In all but one case, which required an additional small skin incision on the glabella, the fracture on the upper nasofrontal buttress was repaired through an extended transcaruncular approach without making any skin incisions. All showed excellent fracture re-alignment on post-surgical CT. Complications happened in three cases; those in two cases were attributed to the extended transcaruncular approach, whereas those in the other were not.
  
  
  CONCLUSIONS
  The extended transcaruncular approach is a promising alternative to current conventional approaches for NOE and Le Fort II fractures, achieving accurate repair without the need for skin incision.
authors: Department of Plastic Surgery, Prefectural Okinawa Chubu Hospital, Aza Miyazato 281, Uruma City, Okinawa, 904-2243, Japan. Electronic address: microboy@icloud.com.
authors: Atsushi
authors: A
authors: Imaizumi
authors: Department of Plastic Surgery, Prefectural Okinawa Chubu Hospital, Aza Miyazato 281, Uruma City, Okinawa, 904-2243, Japan.
authors: Kunihiro
authors: K
authors: Ishida
authors: Department of Plastic and Reconstructive Surgery, Prefectural Nanbu Medical Center/Child Medical Center, Aza Arakawa 118-1, Haebaru Town, Shimajiri County, Okinawa, 901-1193, Japan.
authors: Osamu
authors: O
authors: Nishizeki
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005004:Ethmoid Bone / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008440:Maxillary Fractures / Q000601:surgery*; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries* / Q000601:surgery; D009915:Orbit / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery*; D019340:Osteotomy, Le Fort / Q000379:methods*; D012887:Skull Fractures / Q000601:surgery*; D055815:Young Adult
keywords: Le Fort II fracture; Naso-orbito-ethmoid fracture; Transcaruncular approach