An extended transcaruncular approach for naso-orbito-ethmoid and Le Fort II fracture repair

• Published in: Journal of cranio-maxillo-facial surgery Vol. 44; no. 12; pp. 1922 - 1928
• Main Authors: Imaizumi, Atsushi, MD, Ishida, Kunihiro, MD, Nishizeki, Osamu, MD
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.12.2016
• Subjects: Adolescent; Adult; Child; Dentistry; Ethmoid Bone - injuries; Ethmoid Bone - surgery; Female; Humans; Le Fort II fracture; Male; Maxillary Fractures - surgery; Middle Aged; Nasal Bone - injuries; Nasal Bone - surgery; Naso-orbito-ethmoid fracture; Orbit - surgery; Orbital Fractures - surgery; Osteotomy, Le Fort - methods; Skull Fractures - surgery; Surgery; Transcaruncular approach; Young Adult; Le Fort II fracture; naso-orbito-ethmoid fracture; transcaruncular approach; Transcaruncular approach; Naso-orbito-ethmoid fracture
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2016.09.006

Abstract Recent advancements in computed tomography have enabled the diagnosis of naso-orbito-ethmoid (NOE) fractures to be made in much greater detail. Surgical access to the upper nasofrontal buttress in NOE fractures, however, has remained unchanged over the past decades. All approaches to these fractures using skin incisions have individual drawbacks. The transcaruncular approach is free of the drawbacks of the cutaneous approaches. We further extended the transcaruncular approach for the treatment of NOE and Le Fort II fractures. Eight patients; six with Markowitz's Type I NOE fractures and two with Le Fort II fractures, underwent fracture repair using an extended transcaruncular approach to access the upper nasofrontal buttress. In all but one case, which required an additional small skin incision on the glabella, the fracture on the upper nasofrontal buttress was repaired through an extended transcaruncular approach without making any skin incisions. All showed excellent fracture re-alignment on post-surgical CT. Complications happened in three cases; those in two cases were attributed to the extended transcaruncular approach, whereas those in the other were not. The extended transcaruncular approach is a promising alternative to current conventional approaches for NOE and Le Fort II fractures, achieving accurate repair without the need for skin incision.