Comprehensive management of nasoethmoid-orbital injuries

Fractures of the nasoethmoid-orbital region present some of the more formidable challenges to the reconstructive surgeon in regard to aesthetic and functional restorations. As the severity of injury escalates, the surgical difficulties increase, making acceptable results of therapy difficult to achieve. Optimal management involves not only repair of the skeleton of the central midface, but also restoration of function and aesthetics of the orbits, frontal sinus, anterior cranial fossae, and the overlying soft tissue. Detailed physical examination and radiographic imaging are necessary to properly diagnose the extent of injuries. Various surgical techniques, such as interfragmentary wiring, microplate fixation and transnasal wiring, are utilized. This article reviews injuries of the nasoethmoid-orbital region, and describes the pertinent anatomy and classification of injuries. Currently accepted methods of evaluation and repair of specific injuries are outlined.