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Goh EZ, Bullis S, Beech N, Johnson NR. Surgical management of naso-orbito-ethmoidal fractures: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00093-2. [PMID: 38697897 DOI: 10.1016/j.oooo.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and postoperative outcomes associated with the surgical management of NOE fractures. STUDY DESIGN PubMed and Scopus databases were systematically searched between 1993 and 2023 using the search strategy "(naso-orbito-ethmoidal OR nasoethmoid OR nasoorbitoethmoidal) AND fracture." Articles reporting clinical studies investigating the surgical management of NOE fractures were included. Articles that were duplicates, non-English, or non-full text; reported an unclear age range; reported insufficient data; and/or reported on a sample size less than 10 were excluded. Data on patient factors, procedural factors, and postoperative outcomes were extracted. RESULTS Of the 412 articles identified, 6 eligible articles (retrospective case series) representing 95 adult cases and 84 pediatric cases were included. The mean ages were 29.0 and 10.2 years, respectively. Most cases were male (65.3%; 73.9%). Motor vehicle accidents were the most common mechanism of injury (79.2% and 50.0%, respectively). Coronal incision was the most common approach. Epiphora (n = 33) and scar problems (n = 21) were the most common complications in adult and pediatric cases, respectively. CONCLUSIONS Further robust longitudinal studies with a clear description of fracture classification and surgical timing would be helpful. Gaps in knowledge include concomitant injuries, digitally-assisted applications, and risk factors for adverse outcomes.
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Affiliation(s)
- Elizabeth Z Goh
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Sam Bullis
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Beech
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel R Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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Teoh RLW, Fong PY, Cai EZ, Yap YL, Hing ECH, Lee HJ, Nallathamby V, Ong WC, Lim J, Sundar G, Lim TC. Prophylactic Intraoperative Nasolacrimal Duct Intubation in Surgical Treatment of Facial Fractures—Is There a Role? Arch Plast Surg 2022; 49:195-199. [PMID: 35832673 PMCID: PMC9045536 DOI: 10.1055/s-0042-1744407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures.
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Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (
n
= 280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (
n
= 16), frontal sinus (
n
= 2), Le Fort II/III (
n
= 8), and > 1 type (
n
= 48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (
p
= 0.152) or wound infection (
p
= 0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.
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Affiliation(s)
- Ryan Liang Wei Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pei Yuan Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elijah Zhengyang Cai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Yan Lin Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Eileen Chor Hoong Hing
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Han Jing Lee
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Vigneswaran Nallathamby
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Wei Chen Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Jane Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Gangadhara Sundar
- Division of Oculoplastic Surgery, Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Thiam Chye Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore, Singapore
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Shim WS, Cho MJ, Kim J, Jung HJ. Epiphora after nasolacrimal duct fracture in patients with midfacial trauma: A retrospective study. Medicine (Baltimore) 2019; 98:e18120. [PMID: 31770240 PMCID: PMC6890326 DOI: 10.1097/md.0000000000018120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to identify the factors related to occurrence of epiphora or requirement of dacryocystorhinostomy (DCR) in patients with midfacial trauma.We performed a retrospective analysis of the medical records of 1038 patients with midfacial trauma from January 2005 to December 2015. Fifty-one patients (55 cases) diagnosed with nasolacrimal duct (NLD) fracture using facial bone computed tomography were enrolled. Correlation analysis was performed of patient- and injury-related factors, including age, sex, facial trauma etiology, accompanying injury, type and level of the NLD fracture, and time from injury to initial surgery, with the occurrence of epiphora and requirement for DCR.Epiphora occurred in 14.5% and DCR was performed in 5.5% of the patients with NLD fracture. The correlation analysis revealed no significant relationship among the factors with the occurrence of epiphora and requirement for DCR.In patients with midfacial trauma and NLD fracture, epiphora occurred in 14.5% and endoscopic DCR was performed due to persistent epiphora in 5.5% and its result was all successful.
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Affiliation(s)
- Woo Sub Shim
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Min Jai Cho
- Department of Neurosurgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jisung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery
| | - Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery
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Abstract
The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patientspecific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. This review focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field.
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Affiliation(s)
- Jun-Jun Wei
- State Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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