Menville Jesse, Soliman Luke, Shinde Nidhi, Spake Carole, Francalancia Stephanie, Marquez-Garcia Josue, Sobti Nikhil, Rao Vinay, Woo Albert S
Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Division of Plastic and Reconstructive Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Craniomaxillofac Trauma Reconstr. 2024 Dec;17(4):NP249-NP256. doi: 10.1177/19433875241280781. Epub 2024 Sep 4.
A retrospective study.
The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture).
A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher's Exact Tests.
111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) ( < .001).
While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction.
一项回顾性研究。
马克维茨 - 曼森分类系统根据损伤严重程度和内眦韧带的剩余完整性对鼻眶筛（NOE）骨折进行分类。然而，该系统未考虑骨移位方向（骨折内移位与骨折外移位），而这可能极大地影响症状表现和治疗。我们假设，NOE骨折根据其严重程度会有不同表现：I型损伤可能表现为鼻骨内侧移位（骨折内移位），而III型骨折更易发生外侧移位（骨折外移位）。
对一家一级创伤中心整形外科在6年期间评估的所有NOE骨折患者进行回顾性研究。评估计算机断层扫描数据以评估骨折段移位的方向。通过卡方拟合优度检验和费舍尔精确检验比较不同NOE类型中内侧、外侧和无移位的频率。
111例患者符合纳入标准。患者群体中男性占73.9%，平均年龄51.2岁。当双侧骨折独立计算时，共有141例：I型115例，II型20例，III型6例。I型骨折最常见的是骨折内移位（48.7%），而III型损伤始终是骨折外移位（100%）（P <.001）。
虽然II型和III型NOE骨折一直是临床关注的重点，但本研究强调了I型骨折中嵌顿的普遍性。这些发现提倡对I型NOE骨折及其潜在风险，包括创伤性睑裂狭小和鼻气道阻塞，采用更全面的评估方法。
