Naso-orbital-ethmoid complex fracture management

Naso-orbital-ethmoid complex fracture management requires a thorough understanding of the anatomy of medial orbital structures, particularly the medial canthal tendon apparatus. Modern C/T imaging allows one to accurately define the fracture patterns present and to plan the surgical repair. The key structure in these fractures is the "central segment" of bone to which the medial canthal tendon attaches. It is essential to identify, anatomically reduce and fixate this fragment to prevent post operative telecanthus. Standard craniofacial surgical approaches allow the surgeon to widely expose these fractures with minimal secondary cosmetic deformities. Rigid fixation of the fracture segments with titanium microplating systems allows for accurate and stable fixation in a one stage surgical repair. The assessment, imaging, surgical exposure, fixation and care of these fractures will be discussed. The goal of repair is to reestablish a normal intercanthal distance and to anatomically repair the associated fractures.