New Classification of Naso-Ethmoid-Orbital Fracture using Computerized Tomography

ABSTRACT

Naso-ethmoid-orbital fractures are the most challenging of all craniofacial fractures to treat because of the intricate anatomy of this region and the difficulty in fracture fixation. Inadequate initial treatment will often result in severe deformity that may be extremely difficult or impossible to correct adequately. Naso-ethmoid-orbital injuries have been described in detail by numerous authors, but to date, no adequate classification of these injuries exits. In this study, we reviewed and analyzed the medical records and facial bone CT scans of 66 patients from May 1990 to August 1998 by retrospective analysis method. The pattern of injury in these patients was carefully analyzed in order to formulate a working classification based on clinical features and fracture types. Injuries may be unilateral or bilateral, and three clinical types of fractures have been recognized, each of which may occasionally have a combination of features. The types of fracture were divided into Type I, Type II and Type III. Type I was isolated bony NEO injury (31 cases), Type II was bony NEO injury with maxilla (11 cases) and Type III was extended NEO injury (24 cases). Also, type II was subdivided into 1) Bony NEO injury with central maxillay crush only, 2) with central maxilla and one lateral maxillary crush, and 3) with central and bilateral maxillary crush, and type III was 1) with craniofacial injuries, 2) with Le Fort II and III fractures and 3) with orbital displacement. The recognition and diagnosis of each specific injury pattern by our new classification method will define the correct treatment choice in each case.