Fronto-orbito-nasal dislocations., Secondary treatment of sequelae

Untreated or maltreated fronto-orbito-nasal dislocations can give rise to serious sequelae of a functional or aesthetic nature. Two major problems may be discerned, namely extensive bone loss and malunited fractures. The loss of bone can result in an unfavourable aesthetic appearance and functional disturbances, e.g. loss of eye motility, cerebral herniations and meningitis. The treatment should therefore include protection of the underlying elements, such as eye and meningocerebral tissues with a definite isolation of the cranial content from facial cavities. An important measure to be taken is also the repair of nasal and orbital walls, including re-insertion of the canthal ligaments. Autogenous bone grafting is superior in the repair of bone defects. Malunited fractures are treated by repositioning osteotomies, sometimes including rotation, elevation, or translation. The reposition can be achieved either by advancement of a monobloc or by an expansion. Solid fixation is essential and can be obtained either by an upper fixation to an intermediary frontal bridge or by lateral fixation to safe bone parts with an intermediary bone graft in cases of trauma in the midline. Our approach allows a definite and total repair in one operation and requires repair of the dura mater by suturing and, if necessary, pericranial grafting. In cases of interference of the frontal sinus, 'cranialization' must be performed. In our opinion it is necessary to work in a team including maxillofacial and neurosurgeons.