Merville L C, Real J P
Scand J Plast Reconstr Surg. 1981;15(3):287-97. doi: 10.3109/02844318109103448.
The craniofacial trauma can produce compound fractures with bone displacement in the central part of the upper face, i.e. the bones constituting the forehead, orbit, and nose. such dislocations are called fronto-orbito-nasal dislocations. A total and definite surgical reconstruction in one stage offers advantages such as good aesthetic and functional results. An injured person can enter professional and social life without further delay. A major advantage is also the minimizing of the risk of meningeal fistula with infectious mortal risk. A prerequisite for this surgery is accurate clinical and radiological examination to permit a preoperative three-dimensional visualization of the lesions as a basis for careful planning of the operation. The surgical team should include neurosurgeons and plastic surgeons with experience in the maxillofacial area. The operative procedure should start with repair of the orbital frame, beginning at the upper and lateral side, followed by exploration of the four walls of the orbital chamber and of the lacrimal system. The reconstruction then proceeds with the eyelid ligaments and the nervous and vascular pedicles, especially the infra-orbital one, followed by reconstruction of the sinus maxillaris. Afterwards transnasal internal canthopexy wires are placed, the nose reconstructed and bone grafts are used to restore the orbital chamber behind the frame. The lacrimal system is repaired before the tightening of the canthopexies. In cases where neurosurgical intervention is necessary, such as suturing of dura sores or reconstruction of the anterior cranial fossa by bone grafting, this will precede the facial reconstruction. Without a strong frontal cornice it is impossible to restore the nose and orbit. Ocular injuries are treated by ophthalmic surgeons when the orbit is repaired. The last phase of the reconstruction is suturing of the muscular, mucosal and cutaneous lacerations.
颅面创伤可导致上颌面部中央部位出现伴有骨移位的复合骨折，即构成前额、眼眶和鼻子的骨骼。这种移位称为额眶鼻脱位。一期进行全面且确定的手术重建具有诸多优势，比如能取得良好的美学和功能效果。伤者可立即回归职业和社会生活。另一个主要优势是将伴有感染致死风险的脑膜瘘风险降至最低。该手术的一个前提条件是进行准确的临床和放射学检查，以便术前对病变进行三维可视化，作为精心规划手术的基础。手术团队应包括在颌面领域有经验的神经外科医生和整形外科医生。手术过程应从上外侧开始修复眼眶框架，接着探查眼眶腔的四壁和泪道系统。然后进行眼睑韧带以及神经和血管蒂（尤其是眶下神经血管蒂）的重建，随后重建上颌窦。之后放置经鼻内眦固定线，重建鼻子，并使用骨移植来修复框架后方的眼眶腔。在收紧内眦固定之前修复泪道系统。在需要进行神经外科干预的情况下，比如缝合硬脑膜伤口或通过骨移植重建前颅窝，这将先于面部重建进行。没有坚固的额部檐部就无法修复鼻子和眼眶。在修复眼眶时，眼科医生治疗眼部损伤。重建的最后阶段是缝合肌肉、黏膜和皮肤裂伤。
