Merville L C, Derome P, de Saint-Jorre G
Scand J Plast Reconstr Surg. 1981;15(3):299-305. doi: 10.3109/02844318109103449.
Untreated or maltreated fronto-orbito-nasal dislocations can give rise to serious sequelae of a functional or aesthetic nature. Two major problems may be discerned, namely extensive bone loss and malunited fractures. The loss of bone can result in an unfavourable aesthetic appearance and functional disturbances, e.g. loss of eye motility, cerebral herniations and meningitis. The treatment should therefore include protection of the underlying elements, such as eye and meningocerebral tissues with a definite isolation of the cranial content from facial cavities. An important measure to be taken is also the repair of nasal and orbital walls, including re-insertion of the canthal ligaments. Autogenous bone grafting is superior in the repair of bone defects. Malunited fractures are treated by repositioning osteotomies, sometimes including rotation, elevation, or translation. The reposition can be achieved either by advancement of a monobloc or by an expansion. Solid fixation is essential and can be obtained either by an upper fixation to an intermediary frontal bridge or by lateral fixation to safe bone parts with an intermediary bone graft in cases of trauma in the midline. Our approach allows a definite and total repair in one operation and requires repair of the dura mater by suturing and, if necessary, pericranial grafting. In cases of interference of the frontal sinus, 'cranialization' must be performed. In our opinion it is necessary to work in a team including maxillofacial and neurosurgeons.
未经治疗或治疗不当的额眶鼻骨脱位会引发严重的功能或美学方面的后遗症。可以识别出两个主要问题，即广泛的骨质流失和骨折愈合不良。骨质流失会导致不良的美学外观和功能障碍，例如眼球活动丧失、脑疝和脑膜炎。因此，治疗应包括保护眼部和脑膜脑组织等深层结构，将颅内容物与面部腔隙明确分隔。还应采取的一项重要措施是修复鼻壁和眶壁，包括重新植入内眦韧带。自体骨移植在骨缺损修复方面更具优势。骨折愈合不良通过截骨复位治疗，有时包括旋转、抬高或平移。复位可通过整块推进或扩张来实现。牢固固定至关重要，在中线创伤的情况下，可通过上方固定于中间额桥或通过在安全骨部位进行外侧固定并植入中间骨移植来实现。我们的方法允许在一次手术中进行明确和全面的修复，需要通过缝合修复硬脑膜，必要时进行颅骨膜移植。在额窦受累的情况下，必须进行“颅骨化”。我们认为有必要由颌面外科医生和神经外科医生组成团队开展工作。
