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Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas Medical Branch – UTMB Health Department of Otolaryngology Grand Rounds Presentation November 19, 2014 Series Editor: Francis B. Quinn, Jr., MD, FACS -- Archivist: Melinda Stoner Quinn, MSICS
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Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

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Page 1: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Naso-Orbital Ethmoid Fractures

Resident Physician: S. Ross Patton, MD

Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS

The University of Texas Medical Branch – UTMB Health

Department of Otolaryngology

Grand Rounds Presentation

November 19, 2014

Series Editor: Francis B. Quinn, Jr., MD, FACS -- Archivist: Melinda Stoner Quinn, MSICS

Page 2: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Objectives

1. Review relevant facial anatomy for NOE fractures

2. Review definition and classification of NOE fractures

3. Review surgical approaches and treatment of NOE fractures

Page 3: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://dentoclub.webs.com/apps/photos/photo?photoid=66406077

Background

Page 4: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

NOE Definition

Page 5: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

NOE Region

https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM

!/?segment=Midface&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-

Diagnosis/noe.jsp

Page 6: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Anatomy of NOE Region

Page 7: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Lacrimal Fossa

-http://en.wikipedia.org/wiki/Lacrimal_bone

Page 8: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Orbital Anatomy- Important Distances to Know

Published in Grand Rounds given by AH Muir from UCSF

Page 9: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html

Medial Canthal Tendon

Page 10: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html

Relationship to Other Important Structures

Page 11: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html http://oralmaxillo-facialsurgery.blogspot.com/2010/05/nasoorbitoethmoid-fractures.html

Midface Buttress System

Page 12: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Nomenclature

NOE - naso-orbital ethmoid

NEC - naso-ethmoid complex

Naso ethmoid orbital

Naso-orbital ethmoidal

Page 13: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://www.iihs.org/iktopnews/negative-publicity-about-airbags-obscuring-their-benefit-institute-aihs/news/desdvises-against-disconnecting-airbags-except-in-rare-cases

Mechanism Of Injury

http://www.iihs.org/iihs/news/desktopnews/negative-publicity-about-airbags-obscuring-their-benefit-institute-advises-against-disconnecting-airbags-except-in-rare-cases

Page 14: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://www.sciencedirect.com/science/article/pii/S1042369908001155

Pathophysiology of NOE

Page 15: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Classification

Page 16: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Markowitz Type I

https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf

ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp

Page 17: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Markowitz Unilateral Type II

https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf

ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp

Page 18: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Bilateral Type II Fracture

https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf

ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp

Page 19: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

https://www2.aofoundation.org/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN3QwMDA08zTzdvvxBjIwN_I_2CbEdFADiM_QM!/?segment=Midf

ace&bone=CMF&classification=92-Nasal%2FNOE%2C%20NOE&teaserTitle=&showPage=diagnosis&contentUrl=/srg/92/01-Diagnosis/noe.jsp

Markowitz Type III

Page 20: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Why So Difficult?

Page 21: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Management

Page 22: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Linnau et al 2003

Management: Clinical Presentation in the Trauma Bay

Page 23: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Management: Diagnosis by Exam and Imaging

Page 24: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Physical Exam: Telecanthus

http://dentoclub.webs.com/apps/photos/photo?photoid=66406077

Page 25: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

https://www2.aofoundation.org/wps/portal/!ut/p/c0/

Bowstring Sign Palpation/Instrument

https://www2.aofoundation.org/wps/portal/!ut/p/c0/

Page 26: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Physical Exam: Loss of nasal dorsal Height

Sargent 2007 Sargent 2007

Pigsnout

Deformity

Page 27: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://www.technologybloggers.org/science/is-your-computer-damaging-your-

eyes/

Physical Exam: Epicanthal Folds

Page 28: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Physical Exam: Globe

--http://www.eyecalcs.com/DWAN/pages/v5/ch087/012f.html

Page 29: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Imaging

Page 30: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Plain Films

http://www.bcm.edu/oto/index.cfm?pmid=15481

Water’s ViewCaldwell View

http://www.bcm.edu/oto/index.cfm?pmid=15481

Page 31: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://radiographics.rsna.org/content/26/3/783.figures-only

Coronal CT

Page 32: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Nguyen et al 2010

Axial CT

Page 33: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Axial CT- Finding the lacrimal Fossa

-http://www.ajnr.org/content/22/5/845/F4.expansion.html

-http://www.images.missionforvisionusa.org/anatomy/2005/10/orbit-ct-images.html

Page 34: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Management-Acute Management of Related

Problems: Intracranial trauma

-http://neurosciencenews.com/neurology-children-tbi-concussion-research-263/brain-big-bandaid-public/

Page 35: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Management-Acute Management of Related

Problems: Epistaxis

Page 36: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Planum Sphenoidale

Superior orbital Fissure

Syndrome

Blindness

Epistaxis

-internal carotid

http://emedicine.medscape.com/article/882627-overview#aw2aab6b3

Page 37: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Nasolacrimal Duct Injury

http://care.american-rhinologic.org/epiphora

Page 38: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

http://www.drpaulose.com/general/csf-leak-from-the-nose-how-to-treat

CSF Leak

Page 39: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Management: Surgical Planning Once Stabilized

Page 40: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Timing of Operation

Page 41: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Picking a Surgical Approach

Page 42: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Open Sky Approach

Page 43: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Midface Degloving

Page 44: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Bicoronal Flap

Page 45: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Layers of the Scalp

AO Surgery. Bicoronal Flap. https://www2.aofoundation.org/wps/portal/surgery?showPage=approach&contentUrl=srg/92/04-Approaches/A70_Coronal-approach.jsp&bone=CMF&segment=Midface&approach=Coronal%20approach&Language=en

Page 46: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Video - Bicoronal Approach

http://youtu.be/gVWGklBtZTA

http://youtu.be/gVWGklBtZTA
Page 47: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

https://www2.aofoundation.org/wps/portal/surgery/?contentUrl=%2Fsrg%2F92%2F04-Approaches%2FA30_1-lower-eyelid-

transcutan.jsp&bone=CMF&segment=Midface&showPage=approach&approach=Transcutaneous%20lower-eyelid%20approaches

Additional Incision to approach inferior orbit

Page 48: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Surgical Repair

Page 49: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

General Principles

Which fractures need surgery? ***Almost all- (type I)

Goals of Surgery: Restore pre-injury

appearance/function (if possible)

Other fractures: Treat other fx first

Page 50: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type I Repair

Sargent 2007

Plating Only

Page 51: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair

Sargent 2007

Plating and trans-nasal

wiring

Page 52: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair- Trans-nasal wiring

Sargent 2007

Page 53: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair- Trans-nasal wiring

Page 54: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair- Trans-nasal wiring

Pitfall- don’t drill into the brain

Page 55: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair- Trans-nasal wiring

Page 56: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair- Trans-nasal wiring

Unilateral Repair

Page 57: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair- Trans-nasal wiring

Bilateral Repair

Page 58: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type II Repair

Papel-2nd edition

Type II Repair- Trans-nasal wiring

Pitfall: Placement of wires

Page 59: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type III Repair- Trans-nasal wiring

Page 60: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Type III Repair

Page 61: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Papadopolous et al 2009

Nasal Reconstruction

Page 62: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Nasal Reconstruction: Cantilevered Bone Graft

Page 63: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Sargent 2007

Soft tissue bolsters

Page 64: Naso-Orbital Ethmoid Fractures · Naso-Orbital Ethmoid Fractures Resident Physician: S. Ross Patton, MD Faculty Mentor: Michael P. Underbrink, MD, MBA, FACS The University of Texas

Sources

AO Foundation. “Nasal/NOE”. https://www2.aofoundation.org/

wps/portal/!utc1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hng7BARydDRwN39yBTAyMvLwOLUA93I4MQE6B8JJK8haGF

gYFnqKezn7GTn4GBgQkB3X4e-bmp-

gW5EeUAmUJP3w!!/dl2/d1/L2dJQSEvUUt3QS9ZQnB3LzZfQzBWUUFCMUEwRzFFMTBJREZMVUlRUDEwMDA!/?sho

wPage=diagnosis&bone=CMF&segment=Midface

Kellman RM. Maxillofacial Trauma. Cummings Otolaryngology 5th Edition. Ch 23

Bailey BJ. Nasal Fractures. Head & Neck Surgery- Otolaryngology 4th Edition. Ch 71

Papel ID. Frontal Sinus and Nasoorbitoethmoid Complex Fractures. Facial Plastic and Reconstructive Surgery 2nd

edition.

Donald PJ. Frontal sinus and nasofrontoethmoidal complex fractures. SIPAC. 2002.

Shibuya TY. Chen VY. Oh YS. Naso-orbito-ethmoid fracture management. Operative Techniques in Otolaryngology.

2008;19:140-44.

Naso-orbital ethmoid fractures. Medscape Reference. 2/1/2013. http://emedicine.medscape.com/article/869330-

overview

Nguyen M. Koshy JC. Hollier LH. Pearls of Nasoorbitoethmoid trauma Management. Seminars in Plastic Surgery.

24:4:2010.

Papadopoulos H. Salib NK. Management of Naso-Orbital-Ethmoidal Fractures. Oral Maxillofacial Surg Clin N Am

21(2009) 221-225


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