Poster Session

POSTER 317A Recent 10-year Retrospective Study ofNasal Bone Fracture

M. I. Kim: Chonnam National University, B. Kim,

G. H. Youn, S. Jung, M. S. Kook, H. J. Park, H. K. Oh,

S. Y. Ryu

This study was performed to investigate the incidence,

types of fracture, treatment, associated fractures, andcomplications in patients with nasal bone fracture.

Clinical examination, patient’s records, and radio-

graphic images were evaluated in 358 cases of nasal

bone fractures from 2003 to 2012.

Results of this study are as follows:

1. The age of patient ranged from 4 to 77 years (mean

age=38.8 years); males were 79.7% (n=288), and females

were 21.3% (n=70).2. The cause of the nasal bone fracture in this studywas

a fall or slip down (32.8%, n=119), sports accident

(28.0%, n=81), fighting (16.3%, n=36), traffic accident

(15.6%, n=42), industrial trauma (8.8%, n=25), and the

others (6.9%, n=16)

3. For the patterns of fracture, simple fracture without

displacement occurred in 13.4% (n=45). Simple fracture

with displacement without septal bone fracture wasfound in 51.5% (n=167). Simple fracture with displace-

ment in company with septal bone fracture showed in

32.6% (n=75). Comminuted fracture with severe depres-

sion was present in 8.4% (n=44).

4. The reduction for the displaced nasal bone was car-

ried out in 2 to 10 days (mean 6.8 days) after the injury.

5. Nasal bone fractures were associated with Le Fort I

fracture (7.5%, n=9), Le Fort II fracture (8.4%, n=20), LeFort III fracture (2.3%, n=5), NOE fracture(15.9%, n=37),

ZMC fracture (24.4%, 65), maxillary bone fracture

(12.3%, n=38), orbital blow-out fracture (17.7%, n=42),

frontal bone fracture (1.3%, n=5), and alveolar bone frac-

ture (10.9%, n=32)

6. The major types of treatment method were closed

reduction in 90% (n=307), open reduction in 3%

(n=15), and observation in 7% (n=36).7. There were some complications such as ecchymosis,

hyposmia, hypoesthesia, and residual nasal deformity

which are compatible. Open rhinoplasty was conducted

for 6 patients who had residual nasal deformity.

These results suggest that most of nasal bone fractures

occurred in physically active aged groups (age 10-49

years) and could be treated successfully with closed

reduction at 7 days after the injury.

References:

1. Yilmaz MS, Guven M, Kayabasoglu G, Varli AF: Efficacy of closed

reduction for nasal fractures in children.Br J Oral Maxillofac Surg.

2013 Dec;51(8):e256-8.

2. Gentile MA, Tellington AJ, Burke WJ, Jaskolka MS: Management of

midface maxillofacial trauma. Atlas Oral Maxillofac Surg Clin North Am.

2013 Mar;21(1):69-95

e-230

POSTER 318The Upper Lid Split Orbitotomy: Review ofTechnique and Case Report

G. S. Zinberg: Christiana Care Health System, E. Spencer,

B. Seiff

The surgical approach options are limitedwhen intraco-

nal or superomedial extraconal access is necessary in the

orbit. A transverse upper eyelid approach provides accessto this area, but does so at the expense of transecting

the levator apparatus leading to postoperative ptosis.

Conversely, a vertically oriented incision of the upper

eyelid only divides the muscles and allows appropriate

function post-operatively. Meticulous closure ensures

appropriate realignment of the tarsus and lid border to pro-

vide cosmesis. In the case report included in this review, a

patient sustained multiple gun shot wounds and had a re-tained foreign body in the right superomedial orbit. This

report reviews that case, and the surgical technique.

In order to expose the superomedial orbit or intraconal

space, a vertically oriented, full-thickness incision is

planned. It is designed to be perpendicular to the tarsus

at the junction of the medial third and lateral two thirds

of the upper eyelid. This incision traverses the skin, tarsus,

orbicularis and palpebral conjuctiva. It is critical that thisincision be perpendicular to the lid margin to allow for es-

thetics and to prevent transection of any portion of the le-

vator apparatus. The incision is continued with the

scissors, splitting M€uller’s muscle to the fornix of the

eyelid, extending into the bulbar conjuctiva to the limbus.

The extraconal fat exposed in this space is dissected

bluntly, exposing the superior and medial recti muslces,

as well as the superior oblique. Care must be taken at thisstage not to damage the superior oblique tendon as it loops

posterolaterally from the trochlea. Blunt dissection is uti-

lized to locate the area of surgical interest in the extraconal

or intraconal spaces. Intraconal access is available via

dissection between the superior and medial rectus mus-

cles. Caution is to be had while dissecting in this area to

avoid damaging important neurovascular structures that

came into the field (supraorbital nerves, supratrochlearnerve, infratrochlear nerve, supraorbital artery/vein, supra-

trochlear artery/vein). Upon access to the area of interest,

the planned procedure (biopsy, muscle release, retreival of

foreign body, etc.) can be carried out. After completion of

the procedure, perfect reapproximation of the lid margins

and tarsus during closure allow for cosmesis upon healing.

The patient reported in this review sustained a gunshot

wound to the right cheek with the bullet retained in theright superomedial orbit. Given the location of the bullet

on the available imaging, the most appropriate surgical

approach for foreignbody retrievalwas the vertical lid split.

This approachwas carried out, and the bulletwas retrieved

successfully. Meticulous closure was performed to realign

the tarsus, muscle, skin and conjuctiva and the patient

had a good cosmetic result during his time in follow up.

AAOMS � 2014