Nasal reconstruction with osteocartilaginous grafts in naso-orbito-ethmoid fractures

Introduction: High-energy injuries to the midface often result in naso-orbital-ethmoid (NOE) fractures, either isolated or associated with others. NOE fractures require treatment to restore facial function and aesthetics.

Method: We describe the surgical technique used for nasal reconstruction in II and III NOE fractures at Lomas Verdes Trauma and Orthopedics Hospital from 2011 through 2016. The technique involves suspending the nasal bone remnant, applying bone grafts for the dorsum and cartilage grafts for the nasal tip, distal fixating the nasal septum, and a pericranial flap.

Results: Out of a total of 93 patients diagnosed with NOE fractures, 23 needed reconstructions with this technique, with an average follow-up of 24 months. The only complication was a fistula in the columella, with partial resorption of the grafted cartilage that resolved spontaneously with no aesthetic effect. A patient with telecanthus required an additional operation.

Conclusion: Treatment of NOE fractures requires careful clinical and imaging analysis. The surgical plan should involve the reconstruction of all injured structures, including both bone and soft tissues, particularly the nose. The use of bone and cartilage grafts in the nose should be considered in order to restore nasal height, length and projection.