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

Salvador Valladares Pérez, Diego Bustamante Correa, Gerson Sepúlveda Troncoso
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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
鼻眶筛骨折不同手术入路2例报告
创伤被定义为由于突然暴露于超出其耐受范围的能量源而有意或无意地对生物体造成的损害。反过来,颅面外伤被描述为影响牙槽骨复合体、骨结构和颌面部软组织的创伤鼻-眶-筛复合体骨折位于面中三分之一中段,双侧承受力时为延伸性骨折,美学折衷性高,处理难度大,是颌面外科医生面临的一大挑战鼻眶筛复合体是由鼻骨、鼻中隔、鼻额突、筛、泪骨乳头状层和蝶骨组成的复杂结构,因此这些结构的任何改变都将具有重要的功能和美学意义目前,有几种方法可以进入这些骨折,冠状入路是最常用的,因为它可以正确进入和看到鼻额区。尽管如此,这种方法需要精确和外科专业知识。另一方面,由于切口面积大,毛发较少的患者对美观有相当大的影响以下是智利圣地亚哥El Carmen大都会医院颌面外科团队评估和治疗的两例鼻眶筛骨骨折。两者都需要神经学和眼科的评估,在那个水平上放弃承诺。第一例患者为鼻-眶-筛复合体延伸性骨折,通过鼻额区先前存在的撕裂行入路,并辅以经结膜延伸和外侧眦切开术进入右眶外侧壁和底。第二例患者对应于额部和鼻眶筛骨骨折的患者,该患者通过冠状切口接近。情况下
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