Naso-Orbital-Ethmoid Fracture Repair Techniques: A Systematic Review

Area of Science:

• Maxillofacial surgery
• Orthopedic surgery
• Otolaryngology

Background:

• Naso-orbital-ethmoid (NOE) complex fractures pose significant reconstructive challenges.
• The Markowitz classification system, established in 1991, guides NOE fracture categorization based on medial canthal tendon attachment.
• Understanding current repair strategies is crucial for managing these complex injuries.

Purpose of the Study:

• To systematically review surgical repair techniques for NOE fractures published after the adoption of the Markowitz classification system.
• To analyze the evolution and common practices in NOE fracture management.
• To assess the level of evidence supporting current repair methodologies.

Main Methods:

• Systematic literature search of PubMed, Embase, and Web of Science databases.
• Inclusion of peer-reviewed articles detailing operative techniques for adult NOE fractures post-1991.
• Independent data extraction and assessment of evidence levels using Oxford Centre for Evidence-based Medicine guidelines.

Main Results:

• Sixteen articles, encompassing 517 patients, met the inclusion criteria.
• Open reduction with coronal incisions was the most frequent exposure technique.
• Miniplates, screws, and transnasal wiring were commonly used for rigid fixation, particularly for Type 2 and 3 fractures.
• Ten studies had a Level of Evidence 4.

Conclusions:

• NOE fractures remain complex, with advancements in exposure and multidisciplinary approaches.
• Fixation techniques have shown consistency over time, with surgeon preference playing a key role in outcomes.
• The current low level of evidence necessitates further robust research to evaluate NOE fracture repair techniques.