Merville L C, Derome P, de Saint-Jorre G
J Maxillofac Surg. 1983 Apr;11(2):71-82. doi: 10.1016/s0301-0503(83)80019-8.
Fronto-orbito-nasal dislocation untreated or maltreated can have many important sequelae for both function and aesthetics. Two types of cases may be observed, those with: -extensive bone loss -malunited fracture. The treatment of sequelae caused by bone loss in order to be rational, logical and complete necessitates: 1. protection of the underlying elements = eye and meningo-cerebral tissues, 2. reconstitution of an harmonious cranio-facial profile, 3. definitive isolation of cranial contents from the facial cavities. 4. repair of nasal and orbital walls and the necessary ligamentous re-insertions on them. The best material for such a repair remains the autogenous bone graft. The treatment of sequelae caused by malunited fractures necessitates repositioning osteotomies. In addition to rotation, elevation and translation osteotomies the following may be required: -either a monoblock advancement osteotomy, -or an "expansion" osteotomy. They require solid fixation. This may be obtained by: -either superior fixation to a previously conserved intermediate frontal strut -or a rebuilding of the shape of the vault, laterally fixed to sound bone parts, and an interposed bone graft to act as a "keystone" of the vault. Such repairs seem to be better than simple onlay bone grafts which are useful from an aesthetic point of view, but which neglect the underlying injuries with their concomitant functional sequelae, and which expose the patient to secondary sinus or cerebro-meningeal complications. They permit a single, total, simultaneous, and definitive repair of all the sequelae both functional and aesthetic; an approach which is more rational than successive surgical sessions. But they require: 1. Dura mater repair by suture and pericranial grafting. 2. Total isolation of cranial contents from the face. 3. Obliteration of the frontal sinus. It is therefore necessary to work with a combined neuro- and maxillo-facial team. Four cases are described to illustrate these proposed procedures, one case with very extensive bone loss, three with malunited fractures: the first orbito-frontal, the second with a fronto-zygomatic lateral component, the third with a fronto-nasal medical component.
未经治疗或治疗不当的额眶鼻骨脱位，无论在功能还是美学方面都可能产生许多重要的后遗症。可以观察到两种类型的病例，即伴有：-广泛骨质流失-骨折愈合不良。为了使因骨质流失引起的后遗症的治疗合理、合乎逻辑且完整，需要：1. 保护深层结构=眼睛和脑膜脑组织；2. 重建和谐的颅面轮廓；3. 将颅内容物与面部腔隙彻底隔离；4. 修复鼻壁和眶壁以及在其上进行必要的韧带重新附着。这种修复的最佳材料仍然是自体骨移植。因骨折愈合不良引起的后遗症的治疗需要进行截骨复位。除了旋转、抬高和平移截骨外，可能还需要：-要么进行整块推进截骨术，-要么进行“扩展”截骨术。它们需要牢固固定。这可以通过以下方式实现：-要么向上固定到先前保留的中间额支柱上，-要么重建穹顶形状，向侧面固定到健康的骨部位，并插入一块骨移植作为穹顶的“拱心石”。这种修复似乎比单纯的贴附骨移植更好，单纯贴附骨移植从美学角度看是有用的，但忽略了潜在损伤及其伴随的功能后遗症，并且使患者面临继发性鼻窦或脑脊膜并发症。它们允许对所有功能和美学后遗症进行一次性、全面、同时且确定性的修复；这种方法比连续的手术疗程更合理。但它们需要：1. 通过缝合和颅骨膜移植修复硬脑膜；2. 将颅内容物与面部完全隔离；3. 闭塞额窦。因此，有必要与神经和颌面联合团队合作。描述了四个病例以说明这些提议的手术方法，一个病例有非常广泛的骨质流失，三个病例有骨折愈合不良：第一个是眶额部，第二个有额颧部外侧成分，第三个有额鼻部内侧成分。
