Gruss J S
Plast Reconstr Surg. 1985 Mar;75(3):303-17.
A detailed review of 80 patients with severe naso-ethmoid-orbital injuries has facilitated the classification of these injuries into five types. The recognition and diagnosis of each specific injury pattern will define the correct treatment choice in each instance. Special attention should be focused on injuries with comminution and bone loss in the medial wall and floor of the orbit, with loss of cartilaginous nasal support, and with orbital displacement and dystopia. An open, direct approach to these fractures with meticulous reduction, internal fixation, and repair of the medial canthal ligaments provides optimal repair. The use of craniofacial surgical techniques and immediate bone graft replacement of missing or severely damaged bone will allow reconstruction of even the most difficult injuries in one stage. Two hundred and eighteen primary bone grafts have been utilized in 49 patients. No significant complications with their use have occurred. The incidence of nasolacrimal system injury in naso-ethmoid-orbital injuries is less than suspected. Eight of 46 patients (17.4 percent) required a dacryocystorhinostomy for persistent nasolacrimal system obstruction. Immediate assessment or exploration of the nasolacrimal system is not performed. Delayed assessment and dacryocystorhinostomy resulted in the relief of nasolacrimal system obstruction in all cases.
对80例严重鼻筛眶损伤患者进行的详细回顾，有助于将这些损伤分为五种类型。识别和诊断每种特定的损伤模式将确定每个病例的正确治疗选择。应特别关注眼眶内侧壁和眶底有粉碎性骨折和骨质缺损、鼻软骨支撑结构缺失、眼眶移位和异位的损伤。采用开放、直接的方法处理这些骨折，进行细致的复位、内固定以及修复内眦韧带，可实现最佳修复效果。运用颅面外科技术并立即用骨移植替代缺失或严重受损的骨组织，即使是最复杂的损伤也能一期重建。49例患者共使用了218块自体骨移植。使用过程中未出现明显并发症。鼻筛眶损伤中鼻泪系统损伤的发生率低于预期。46例患者中有8例（17.4%）因鼻泪系统持续阻塞而需要进行泪囊鼻腔吻合术。未对鼻泪系统进行即刻评估或探查。延迟评估和泪囊鼻腔吻合术在所有病例中均缓解了鼻泪系统阻塞。
