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Nasofrontomaxilloethmoid Fracture Patterns: Challenges to Current Clinical Nomenclature
Brandon J. De Ruiter, MD; Vikas S. Kotha, MD; Edward H. Davidson, MD
University Hospitals/Case Western Reserve University Medical Center
2021-01-29
Presenter: Brandon James De Ruiter
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Edward H. Davidson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Naso-orbito-ethmoid (NOE) fractures present significant clinical challenges in diagnosis and management. Current classification systems stratify severity of injury, but do not actively guide management. Furthermore, there is no orbital bone, and hence the term NOE creates vague terminology. This study proposes novel nomenclature (Naso-fronto-ethmoidal (NFE), Naso-maxillo-ethmoid (NME), and Naso-fronto-maxillo-ethmoid (NFME)) that guides surgical approach and predicts risk of associated soft-tissue injuries.
METHODS:
A seven-year (2014-2020) multi-center retrospective analysis of NOE fractures was performed, NFE/NME/NFME classification types were assigned and verified by two investigators, correlated with treatment course (surgical approach if operative) and soft-tissue sequelae (incidence of CSF leak, nasofrontal duct injury, medial canthal tendon injury and nasolacrimal injury).
RESULTS:
Twenty-four patients with twenty-nine NOE fractures (including bilateral injuries) were reclassified as NME (69%), NFE (7%), and NFME (24%). Eighteen patients were managed operatively. NFE fractures were characterized by increased risk of nasofrontal duct injury (100%) and approached by coronal incision (+/- eyelid/glabella incision). NME fractures were characterized by increased risk of medial canthal tendon injury (10%) and nasolacrimal duct injury (25%) and approached by eyelid and intraoral upper gingivobuccal sulcus incisions (+/- glabella incision). NFME fractures were characterized by increased risk of CSF leak (14%) and/or nasofrontal duct injury (14%), and nasolacrimal duct injury (29%), and approached by coronal and intraoral upper gingivobuccal sulcus incisions (+/- eyelid/glabella incision).
CONCLUSIONS:
This novel classification system provides an anatomic basis for guiding management of surgical approach to midface fractures with each fracture type demonstrating an optimal surgical approach and soft-tissue sequelae profile.
