Fronto-Orbito Nasal Dislocations: Initial Total Reconstruction

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Abstract
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.

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