1) NOE fractures involve the nose, orbit, ethmoids, and frontal sinus floor, including the medial canthal tendon attachment area.
2) Classification systems include the Markowitz system of Types I-III based on medial canthal tendon involvement and displacement.
3) Treatment involves open reduction and internal fixation to restore anatomy, including medial canthal tendon reconstruction using transnasal wiring or plating.
NASO-ORBITO-ETHMOIDAL fracture and managementMd Roohia
The naso-orbital ethmoid (NOE) fracture involves the area where the nose, orbit, ethmoids, frontal sinus, and anterior cranial base meet. NOE fractures are different than isolated nasal bone fractures but are often associated with them. The NOE complex involves the confluence of multiple facial bones. Proper treatment of NOE fractures aims to restore the bony and soft tissue structures of the region to preserve orbital and nasal function. Fractures are classified according to degree of comminution and detachment of the medial canthal tendon to guide appropriate open reduction and internal fixation techniques.
Naso-orbital-ethmoid (NOE) fractures: Management principles, options and rec...Dibya Falgoon Sarkar
Naso-orbital-ethmoid fractures involve the nasal bones, ethmoid bone, lacrimal bone, maxilla, and frontal bone. They are complex injuries that can damage the lacrimal apparatus and cause complications like epiphora. Diagnosis involves CT scans and clinical exams. Management principles include early repair, precise fixation to restore anatomy, and grafting of bone defects. Potential complications include telecanthus, enophthalmos, and cerebrospinal fluid leaks.
The Weber-Fergusson incision is indicated for access to tumors involving the maxilla extending superiorly to the infraorbital nerve and into or involving the orbit. It provides wide access to all areas of the maxilla. The incision line is drawn through the vermillion border along the filtrum of the lip, extending around the base of the nose along the facial nasal groove. It then extends infraorbitally below the cilium to the lateral canthus. Tarsorrhaphy sutures are placed in the eyelid. The incision is made through the skin and subcutaneous tissue along the nose, and the full thickness upper lip is transsected with ligation of the labial artery
The document discusses naso-orbito-ethmoidal (NOE) fractures, which involve the central upper midface region. It describes the anatomy and classification of NOE fractures. Markowitz classification system categorizes NOE fractures into 5 types based on the status of the central bony fragment and involvement of the medial canthal tendon. Type I and II fractures involve a single or displaced central fragment with an intact tendon. Type III fractures have comminution beneath the tendon. Imaging such as CT is important for diagnosis.
The naso-orbitoethmoid complex (NOE) fracture represents the most wearisome and challenging of all facial fractures due to the complexity and intricacy of its surgical & anatomic components. A good working knowledge with regards its surgical anatomy, clinical features, sequence of treatment & surgical approaches, potential pitfalls in its treatment & postoperative consideration,. Appropriate diagnosis and timely treatment is crucial to avoid unfavorable & difficult to treat sequelae.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
This document discusses various surgical approaches to the temporomandibular joint (TMJ). It begins by outlining important anatomical structures in the region, including nerves, arteries and layers of fascia. It then describes several common approaches - preauricular, endaural, postauricular, submandibular, retromandibular and intraoral. For each approach, it provides details on the surgical technique, indications, advantages and disadvantages. References are also provided at the end for further reading on the surgical anatomy of the cervical and mandibular distributions of the facial nerve.
NASO-ORBITO-ETHMOIDAL fracture and managementMd Roohia
The naso-orbital ethmoid (NOE) fracture involves the area where the nose, orbit, ethmoids, frontal sinus, and anterior cranial base meet. NOE fractures are different than isolated nasal bone fractures but are often associated with them. The NOE complex involves the confluence of multiple facial bones. Proper treatment of NOE fractures aims to restore the bony and soft tissue structures of the region to preserve orbital and nasal function. Fractures are classified according to degree of comminution and detachment of the medial canthal tendon to guide appropriate open reduction and internal fixation techniques.
Naso-orbital-ethmoid (NOE) fractures: Management principles, options and rec...Dibya Falgoon Sarkar
Naso-orbital-ethmoid fractures involve the nasal bones, ethmoid bone, lacrimal bone, maxilla, and frontal bone. They are complex injuries that can damage the lacrimal apparatus and cause complications like epiphora. Diagnosis involves CT scans and clinical exams. Management principles include early repair, precise fixation to restore anatomy, and grafting of bone defects. Potential complications include telecanthus, enophthalmos, and cerebrospinal fluid leaks.
The Weber-Fergusson incision is indicated for access to tumors involving the maxilla extending superiorly to the infraorbital nerve and into or involving the orbit. It provides wide access to all areas of the maxilla. The incision line is drawn through the vermillion border along the filtrum of the lip, extending around the base of the nose along the facial nasal groove. It then extends infraorbitally below the cilium to the lateral canthus. Tarsorrhaphy sutures are placed in the eyelid. The incision is made through the skin and subcutaneous tissue along the nose, and the full thickness upper lip is transsected with ligation of the labial artery
The document discusses naso-orbito-ethmoidal (NOE) fractures, which involve the central upper midface region. It describes the anatomy and classification of NOE fractures. Markowitz classification system categorizes NOE fractures into 5 types based on the status of the central bony fragment and involvement of the medial canthal tendon. Type I and II fractures involve a single or displaced central fragment with an intact tendon. Type III fractures have comminution beneath the tendon. Imaging such as CT is important for diagnosis.
The naso-orbitoethmoid complex (NOE) fracture represents the most wearisome and challenging of all facial fractures due to the complexity and intricacy of its surgical & anatomic components. A good working knowledge with regards its surgical anatomy, clinical features, sequence of treatment & surgical approaches, potential pitfalls in its treatment & postoperative consideration,. Appropriate diagnosis and timely treatment is crucial to avoid unfavorable & difficult to treat sequelae.
A flap is a unit of tissue that is transferred from one site (donor site) to another (recipient site) while maintaining its own blood supply or from a anastomised vessel.
Flaps come in many different shapes and forms. They range from simple advancements of skin to composites of many different types of tissue
This document discusses various surgical approaches to the temporomandibular joint (TMJ). It begins by outlining important anatomical structures in the region, including nerves, arteries and layers of fascia. It then describes several common approaches - preauricular, endaural, postauricular, submandibular, retromandibular and intraoral. For each approach, it provides details on the surgical technique, indications, advantages and disadvantages. References are also provided at the end for further reading on the surgical anatomy of the cervical and mandibular distributions of the facial nerve.
Panfacial fractures involve multiple facial bones, including the frontal bones, zygomaticomaxillary complex, naso-orbitoethmoid region, maxilla and mandible. Due to the complex nature of these injuries, management requires careful planning and sequencing of treatment to restore facial functions, features and symmetry. Key goals are to reestablish occlusion, stabilize major facial supports to restore three-dimensional contour, and provide a stable scaffold for soft tissue healing. Proper imaging, surgical approaches and attention to anatomical landmarks are important to achieve accurate reduction and fixation.
The document provides information on condylar fractures, including:
1. Condylar fractures account for 26-40% of all mandible fractures and can result in pain, dysfunction and deformity if not treated properly.
2. The condyle has a unique anatomy and is an important growth center for the mandible. Fractures can occur in the condylar head, neck or subcondylar region.
3. Various classification systems are described that categorize fractures by location, degree of displacement, and direction of forces involved. Accurate classification is important for determining appropriate treatment.
This document discusses mandibular fractures, including:
- The anatomy and common sites of fracture in the mandible.
- Various classification systems used to describe fracture location and complexity.
- Clinical signs seen with mandibular fractures like swelling, step deformities, and malocclusion.
- Radiographic tools like panoramic x-rays, CT scans, and occlusal views used to diagnose and characterize fractures.
- Principles of managing mandibular fractures through techniques like open reduction and internal fixation.
This document provides an overview of Lefort I osteotomy, including:
- A brief history describing the development of maxillary osteotomy techniques.
- Anatomical considerations and the biologic basis for maxillary osteotomies, which have shown adequate blood supply can be maintained.
- Indications for Lefort I osteotomy include altering vertical dimension, anteroposterior movements, and surgical expansion of the maxilla.
- Types of Lefort I osteotomies are described, including classic, quadrangular, and segmental variations. Postoperative management and potential complications are also outlined.
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
The nasolabial flap is used to reconstruct defects of the nose, lower eyelid, cheek, lip, oral commissure and anterior oral cavity. It has a reliable blood supply from the facial and angular arteries. The flap can be raised in a superior or inferior direction and is outlined along the nasolabial fold. The technique involves raising the flap in a supra-muscular plane and transferring it to the defect site through a transoral tunnel. Advantages are a concealed donor site scar and good color and texture match. Complications include infection, necrosis and asymmetry.
Panfacial fractures involve fractures of the upper, middle, and lower thirds of the face which can result in collapsed facial dimensions and malocclusion. They also often involve concomitant injuries. The main goals in treatment are to reestablish facial projection, height, width, and symmetry as well as functional occlusion. Several approaches have been used including top-to-bottom, bottom-to-top, and outside-in. The bottom-to-top approach addresses mandibular fractures first to restore lower facial height and width before fixing the maxilla. The top-to-bottom approach establishes the outer facial frame like the zygomas before working inward. Immediate postoperative care focuses on monitoring for complications and rehabilitation aims
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
This document provides an overview of various osteotomy approaches for accessing lesions in the skull base and neck. It discusses the history, classification, advantages, and disadvantages of different osteotomies. Key approaches mentioned include fronto-nasal-orbital osteotomy, Lefort I osteotomy, zygomatic osteotomy, and mandibulotomy. The document emphasizes that the choice of osteotomy depends on factors like the location and extent of the lesion as well as involvement of surrounding structures. Modifications to standard approaches are also described to optimize exposure and resection of different pathologies.
The document discusses different incision techniques for lip splitting surgeries. It describes various incisions used for lower and upper lip splitting, including the Roux-Trotter, McGregor, Robson, Bhatt, Hayter, Rassekh, Weber-Ferguson, and Altemir incisions. It emphasizes that incisions should follow relaxed skin tension lines to minimize scarring, protect important structures like nerves and vessels, and allow for adequate exposure while achieving good functional and cosmetic outcomes. The Hayter incision, which incorporates a chevron shape into the vermilion border, is highlighted as one of the best techniques.
This document provides an overview of nasal and naso-orbito-ethmoid (NOE) fractures. It begins with the anatomy of the nasal region and classifications of nasal and NOE fractures. It then discusses the etiology, clinical features, diagnosis and treatment of these types of fractures. For treatment, it focuses on closed manipulation as well as classifications that guide surgical approaches for NOE fractures. Key examination techniques are also summarized, such as assessing the medial canthal ligament and diagnosing cerebrospinal fluid leaks.
The document describes the pectoralis major island flap technique. It can be used for reconstruction of the pharynx, tongue, face, neck, and skullbase defects. The flap has a large arc of rotation from the clavicle to the xiphoid process. It provides a single stage transfer with a muscle carrier but does not match the color and texture of facial skin. The document outlines the surgical technique including flap design, elevation of the vascular pedicle, and closure of the donor site. Variations including osteomyocutaneous flaps with rib bone and use of the flap as a free tissue transfer are also discussed. Complications, risk factors, and modifications to the technique are summarized.
Nasal fractures are common injuries that result from blunt force trauma to the nose. The nasal bones are the most frequently fractured part of the facial skeleton due to their prominent location and thin structure. Nasal fractures are often classified based on the direction and extent of displacement. Diagnosis involves history, physical exam, and imaging. Treatment ranges from closed reduction for non-displaced fractures to open reduction for severely displaced fractures. Closed reduction involves manipulating the bones back into position using nasal speculums and forceps followed by splinting.
Apertognathia and its surgical managementHimanshu Soni
Hullihen performed the first "V" shaped osteotomy of the mandible to correct anterior open bites. Kole modified this procedure by excising a wedge of bone from the mandible's symphysis and inferior border to shorten facial height. Thoma suggested Y-shaped and trapezoid mandibular body osteotomies to correct open bites associated with prognathism.
Surgical anatomy of Noe complex in context of traumaDr. Hani Yousuf
1) The document discusses the surgical anatomy of the naso-orbito-ethmoidal complex and fractures in this region.
2) It describes the bones, cavities, blood supply, soft tissues like the medial canthal tendon and lacrimal apparatus.
3) Signs of NOE fractures include facial edema, eye pain, telecanthus, and nasal injuries like saddle nose deformity.
4) NOE fractures are classified based on the status of the central bone fragment and involvement of surrounding structures.
This PowerPoint presentation provides a concise and technical exploration of NOE fractures, encompassing fracture classifications, diagnostic modalities, and treatment approaches. Delve into the intricacies of fracture pathology, radiological assessments, and surgical interventions
Panfacial fractures involve multiple facial bones, including the frontal bones, zygomaticomaxillary complex, naso-orbitoethmoid region, maxilla and mandible. Due to the complex nature of these injuries, management requires careful planning and sequencing of treatment to restore facial functions, features and symmetry. Key goals are to reestablish occlusion, stabilize major facial supports to restore three-dimensional contour, and provide a stable scaffold for soft tissue healing. Proper imaging, surgical approaches and attention to anatomical landmarks are important to achieve accurate reduction and fixation.
The document provides information on condylar fractures, including:
1. Condylar fractures account for 26-40% of all mandible fractures and can result in pain, dysfunction and deformity if not treated properly.
2. The condyle has a unique anatomy and is an important growth center for the mandible. Fractures can occur in the condylar head, neck or subcondylar region.
3. Various classification systems are described that categorize fractures by location, degree of displacement, and direction of forces involved. Accurate classification is important for determining appropriate treatment.
This document discusses mandibular fractures, including:
- The anatomy and common sites of fracture in the mandible.
- Various classification systems used to describe fracture location and complexity.
- Clinical signs seen with mandibular fractures like swelling, step deformities, and malocclusion.
- Radiographic tools like panoramic x-rays, CT scans, and occlusal views used to diagnose and characterize fractures.
- Principles of managing mandibular fractures through techniques like open reduction and internal fixation.
This document provides an overview of Lefort I osteotomy, including:
- A brief history describing the development of maxillary osteotomy techniques.
- Anatomical considerations and the biologic basis for maxillary osteotomies, which have shown adequate blood supply can be maintained.
- Indications for Lefort I osteotomy include altering vertical dimension, anteroposterior movements, and surgical expansion of the maxilla.
- Types of Lefort I osteotomies are described, including classic, quadrangular, and segmental variations. Postoperative management and potential complications are also outlined.
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
The nasolabial flap is used to reconstruct defects of the nose, lower eyelid, cheek, lip, oral commissure and anterior oral cavity. It has a reliable blood supply from the facial and angular arteries. The flap can be raised in a superior or inferior direction and is outlined along the nasolabial fold. The technique involves raising the flap in a supra-muscular plane and transferring it to the defect site through a transoral tunnel. Advantages are a concealed donor site scar and good color and texture match. Complications include infection, necrosis and asymmetry.
Panfacial fractures involve fractures of the upper, middle, and lower thirds of the face which can result in collapsed facial dimensions and malocclusion. They also often involve concomitant injuries. The main goals in treatment are to reestablish facial projection, height, width, and symmetry as well as functional occlusion. Several approaches have been used including top-to-bottom, bottom-to-top, and outside-in. The bottom-to-top approach addresses mandibular fractures first to restore lower facial height and width before fixing the maxilla. The top-to-bottom approach establishes the outer facial frame like the zygomas before working inward. Immediate postoperative care focuses on monitoring for complications and rehabilitation aims
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
This document provides an overview of various osteotomy approaches for accessing lesions in the skull base and neck. It discusses the history, classification, advantages, and disadvantages of different osteotomies. Key approaches mentioned include fronto-nasal-orbital osteotomy, Lefort I osteotomy, zygomatic osteotomy, and mandibulotomy. The document emphasizes that the choice of osteotomy depends on factors like the location and extent of the lesion as well as involvement of surrounding structures. Modifications to standard approaches are also described to optimize exposure and resection of different pathologies.
The document discusses different incision techniques for lip splitting surgeries. It describes various incisions used for lower and upper lip splitting, including the Roux-Trotter, McGregor, Robson, Bhatt, Hayter, Rassekh, Weber-Ferguson, and Altemir incisions. It emphasizes that incisions should follow relaxed skin tension lines to minimize scarring, protect important structures like nerves and vessels, and allow for adequate exposure while achieving good functional and cosmetic outcomes. The Hayter incision, which incorporates a chevron shape into the vermilion border, is highlighted as one of the best techniques.
This document provides an overview of nasal and naso-orbito-ethmoid (NOE) fractures. It begins with the anatomy of the nasal region and classifications of nasal and NOE fractures. It then discusses the etiology, clinical features, diagnosis and treatment of these types of fractures. For treatment, it focuses on closed manipulation as well as classifications that guide surgical approaches for NOE fractures. Key examination techniques are also summarized, such as assessing the medial canthal ligament and diagnosing cerebrospinal fluid leaks.
The document describes the pectoralis major island flap technique. It can be used for reconstruction of the pharynx, tongue, face, neck, and skullbase defects. The flap has a large arc of rotation from the clavicle to the xiphoid process. It provides a single stage transfer with a muscle carrier but does not match the color and texture of facial skin. The document outlines the surgical technique including flap design, elevation of the vascular pedicle, and closure of the donor site. Variations including osteomyocutaneous flaps with rib bone and use of the flap as a free tissue transfer are also discussed. Complications, risk factors, and modifications to the technique are summarized.
Nasal fractures are common injuries that result from blunt force trauma to the nose. The nasal bones are the most frequently fractured part of the facial skeleton due to their prominent location and thin structure. Nasal fractures are often classified based on the direction and extent of displacement. Diagnosis involves history, physical exam, and imaging. Treatment ranges from closed reduction for non-displaced fractures to open reduction for severely displaced fractures. Closed reduction involves manipulating the bones back into position using nasal speculums and forceps followed by splinting.
Apertognathia and its surgical managementHimanshu Soni
Hullihen performed the first "V" shaped osteotomy of the mandible to correct anterior open bites. Kole modified this procedure by excising a wedge of bone from the mandible's symphysis and inferior border to shorten facial height. Thoma suggested Y-shaped and trapezoid mandibular body osteotomies to correct open bites associated with prognathism.
Surgical anatomy of Noe complex in context of traumaDr. Hani Yousuf
1) The document discusses the surgical anatomy of the naso-orbito-ethmoidal complex and fractures in this region.
2) It describes the bones, cavities, blood supply, soft tissues like the medial canthal tendon and lacrimal apparatus.
3) Signs of NOE fractures include facial edema, eye pain, telecanthus, and nasal injuries like saddle nose deformity.
4) NOE fractures are classified based on the status of the central bone fragment and involvement of surrounding structures.
This PowerPoint presentation provides a concise and technical exploration of NOE fractures, encompassing fracture classifications, diagnostic modalities, and treatment approaches. Delve into the intricacies of fracture pathology, radiological assessments, and surgical interventions
Access osteotomies in oral & cranio-maxillofacial surgeryDr Rayan Malick
This document discusses various surgical approaches and osteotomies for accessing lesions in the skull base and deep neck spaces. It begins with an introduction and history of access osteotomy. It then discusses the indications, classifications, advantages/disadvantages of different approaches like Lefort I/II osteotomies, zygomatic osteotomies, and transpalatal approaches. Specific approaches like fronto-orbitozygomatic and transnaso-orbitomaxillary are also summarized. The goal of these osteotomies is to provide direct surgical access while minimizing trauma.
This document discusses orbital anatomy and naso-orbito-ethmoidal (NOE) fractures. It describes the NOE region, causes of NOE fractures, and provides a classification system for NOE fractures. Type I fractures involve one large central fragment, while Types II and III involve a comminuted central fragment. Clinical presentations and diagnosis via CT imaging are outlined. Treatment requires a multidisciplinary approach and surgical stabilization of the central NOE fragment to restore normal anatomy.
This document provides an overview of endodontic surgery. It begins with definitions and a brief history of endodontic surgery. It then discusses indications, contraindications, classifications of endodontic surgeries, and recent advances. The document covers various surgical procedures like incision and drainage, flap design, osteotomy, periradicular curettage, root-end resection, root-end preparation, and root-end filling. It provides details on techniques, principles, and advantages/disadvantages of these procedures. Overall, the document serves as a comprehensive guide to endodontic surgery.
This document provides information on the Ramus osteotomy procedure, specifically the sagittal split osteotomy (SSO). It discusses the history and evolution of the SSO technique from its early developments to modern procedures. Key steps of the current SSO procedure are outlined, including incision, dissection, identification of anatomical landmarks, and performing the osteotomies along the medial ramus, vertical body, and buccal cortex before splitting the mandible. The SSO allows correction of mandibular deformities by repositioning the proximal and distal segments.
This document provides information about maxillary sinus augmentation. It begins with an introduction discussing the anatomy of the maxillary sinus and the need for sinus augmentation when there is inadequate bone height for dental implant placement. It then describes the two main techniques for sinus augmentation - direct sinus lift using a lateral window approach and indirect sinus lift using a crestal approach. The document provides details of the surgical procedures, instrumentation, and grafting materials used for both techniques. It emphasizes the importance of thorough preoperative evaluation and planning to ensure successful outcomes.
1) The nasal bone is the most commonly fractured facial bone due to its location and thin structure.
2) Nasal bone fractures are typically caused by blunt trauma to the nose and result in bruising, swelling, and nasal deformities.
3) Diagnosis is usually made clinically but CT scans may be used to evaluate septal fractures or deviation. Treatment ranges from ice, antibiotics, and nasal splinting for minor fractures to closed or open reduction with plates/screws for more severe fractures.
Dorsal reduction rhinoplasty by snehlata.pptxSmMohar1
This document discusses dorsal reduction rhinoplasty to reduce a hump on the nasal dorsum. It describes the anatomy of the nasal dorsum and different types of humps. Techniques for reducing both bony and cartilaginous humps are covered, including dehump, osteotomies, rasping, drilling, and spreader grafts. Complications like ski slope nose and inverted V deformity are also mentioned. The goal of dorsal reduction rhinoplasty is to reshape the nasal dorsum and improve nasal aesthetics or breathing.
Dorsal reduction rhinoplasty by snehlata.pptxSmMohar1
This document discusses dorsal reduction rhinoplasty to reduce a hump on the nasal dorsum. It describes the anatomy of the nasal dorsum and different types of humps. Techniques for reducing both bony and cartilaginous humps are covered, including dehump, osteotomies, rasping, drilling, and spreader grafts. Complications like ski slope nose and inverted V deformity are also mentioned. The goal of dorsal reduction rhinoplasty is to reshape the nasal dorsum and improve nasal aesthetics or breathing.
Septoplasty is a surgical procedure to correct a deviated nasal septum. The nasal septum divides the nose into two cavities and provides structural support. Techniques for septoplasty have evolved over time from early excisions of entire septal segments to today's emphasis on preservation and realignment. A standard modern procedure recognizes mucosal preservation as a primary goal and uses a submucosal approach. Septoplasty is indicated when a deviated septum causes nasal obstruction or recurrent infections. Pre-operative testing such as acoustic rhinometry or rhinomanometry can evaluate the airway before septoplasty.
The document discusses orbital fractures, including:
1. The anatomy of the orbit and its blood supply/nerve supply.
2. Types of orbital fractures such as blowout fractures, blow-in fractures, and fractures involving the orbital rim.
3. Clinical features, diagnosis, and treatment of orbital fractures including surgical approaches, reconstruction materials, and management.
This document provides information about maxillary orthognathic surgery. It discusses the history and types of maxillary osteotomies performed, including Lefort I, II, and III osteotomies. Lefort I osteotomy is described as the workhorse procedure used to correct functional and aesthetic maxillary issues. Complications, patient satisfaction rates, and surgical techniques for performing the various maxillary osteotomies are summarized.
The naso-orbito-ethmoidal (NOE) region consists of a complex of delicate bones that form the central upper midface. Fractures in this region can be challenging to manage due to the anatomy. The NOE region contains four cavities and is reinforced by vertical and horizontal buttresses. It is supplied by arteries and innervated by branches of the trigeminal nerve. Clinical evaluation of NOE fractures involves examining for signs of injuries to the nose, eyes, medial canthal tendon, and possible intracranial involvement. Classification systems help determine fracture patterns and guide management.
This document provides an overview of mandibular orthognathic procedures. It begins with an introduction to orthognathic surgery and the history of mandibular osteotomies. It then discusses anatomical and physiological considerations, timing of osteotomies, and various osteotomy techniques including vertical ramus, sagittal split, horizontal ramus, subapical, and total alveolar osteotomies. It also briefly touches on soft tissue changes and complications that can occur with mandibular osteotomies. The document is intended as a reference for various mandibular orthognathic procedures.
The document discusses the treatment of naso-orbital-ethmoid (NOE) fractures. The main objectives of treatment are to manage the medial canthal tendon to restore intercanthal distance, and restore collapsed nasal projection and orbital volumes. Treatment strategies include closed management for minimal displacement, and open exploration with internal fixation for significant displacement, tendon detachment, loss of nasal height, or increased orbital volume. The most common surgical approach is a coronal flap combined with lower lid incisions. Potential complications include issues with soft tissues, intercanthal measurements, nasal asymmetry, scarring, orbital positioning, tear duct injury.
endodontic surgery and its current concepts boris saha
This document provides an overview of endodontic surgery and its concepts. It discusses the history and evolution of endodontic surgery techniques. It also covers indications for endodontic surgery, classifications of different surgical procedures, and considerations for pre-surgical treatment planning. Key surgical steps like flap design, osteotomy, and root-end resection are summarized.
The document discusses the management of naso-orbito-ethmoid (NOE) complex fractures. It begins with an introduction to the complex anatomy of the NOE region and complications that can arise from inadequately repaired fractures. It then describes the relevant anatomy including bones, buttresses, the medial canthal tendon, and lacrimal apparatus. Patient evaluation methods such as clinical findings, examination techniques, and radiological imaging are covered. The fracture classification system and treatment approaches including surgical exposure, fracture repair techniques, and follow up care are summarized.
The document discusses maxillary orthognathic procedures, including common dentofacial deformities involving the maxilla, diagnosis and treatment planning, surgical anatomy and approaches, types of mid-face osteotomies, and potential complications. It describes techniques for anterior and posterior segmental maxillary osteotomies, as well as total maxillary osteotomies including LeFort I, II, and III procedures. Complications addressed include vascular compromise, hemorrhage, and infection.
Caudal septal deviation refers to deviation of the anterior portion of the nasal septum. It can cause functional and cosmetic issues. Various surgical techniques are used to correct caudal septal deviation, including swinging door techniques, cross-hatching and scoring incisions, septal batten grafts, tongue-in-groove techniques, marionette septoplasty, Jang septoplasty, septal cartilage traction suture techniques, and septal extension grafts. These techniques aim to straighten and stabilize the deviated caudal septum through maneuvers such as cartilage resection, incisions, graft placement, and suturing.
Semelhante a Naso orbito ethmoid (noe) complex fracture (20)
open versus closed reduction of adult condylar fracturesailesh kumar
This document reviews the evolution of treatment approaches for adult mandibular condyle fractures. It summarizes literature comparing outcomes of open reduction with internal fixation (ORIF) versus closed reduction with maxillomandibular fixation (CRMMF). While CRMMF was traditionally preferred, more recent studies show higher complication rates with CRMMF, including malocclusion, asymmetry and limited mobility. ORIF is associated with better anatomic reconstruction and outcomes. The document outlines classification systems for condyle fractures and indications for different treatment methods based on displacement and stability. It also reviews techniques used for ORIF and concludes that based on reviewed literature, ORIF provides better outcomes and is the preferred approach for treating condyle fractures.
The document discusses the anatomy of the temporomandibular joint, labeling structures like the articular eminence, condyle, and glenoid fossa. It notes that synovial fluid in the joint is derived from plasma by dialysis and secretion from synoviocytes, and that the upper compartment can hold approximately 1.2 ml of fluid without pressure while the lower compartment holds around 0.5 ml.
Low Level LASER therapy in impaction socketsailesh kumar
The document discusses the history and applications of low-level laser therapy (LLLT). It summarizes three studies that examined the use of LLLT to reduce pain, swelling, and trismus following surgical removal of impacted third molars. The first study applied laser intraorally and extraorally immediately and 24 hours after surgery. It found reduced pain, swelling, and increased interincisal opening with laser. The second study used a zonal laser technique and found reductions in pain and swelling, though not statistically significant. The third study applied intraoral laser once and found significantly reduced pain compared to medication alone. Overall, LLLT shows potential for improving outcomes following third molar surgery, but standardized power settings are needed
Differential diagnosis of orofacial painsailesh kumar
Differential diagnosis of orofacial pain can be divided into acute and chronic categories. Acute pain includes dental, periodontal, sinus, and salivary gland issues and is usually inflammatory in origin. Chronic pain includes myofascial pain, TMJ disorders, migraines, and various neuropathies. Neuropathic pain includes trigeminal neuralgia, postherpetic neuralgia, glossopharyngeal neuralgia, and complex regional pain syndrome. Management depends on the underlying cause and includes medications, physical therapy, and occasionally surgery.
Late mandibular fracture occurring in the postoperative periodsailesh kumar
This systematic review analyzed 124 cases of late mandibular fractures occurring after surgical removal of lower third molars. It found that fractures most often occurred on the left side, involved teeth in positions II and C according to classification systems, and were of the mesioangular or vertical variety. Common causes of fracture included mastication and most fractures presented with crackling sounds and pain within 2-3 weeks of extraction. Management often involved non-surgical treatment such as a soft diet. The review concluded that risk of late fracture is associated with excessive bone removal during surgery and that further prospective studies are needed.
Role of radiotherapy in oral ca ppt for csmsailesh kumar
Radiotherapy plays an important role in the management of oral cancer. It uses ionizing radiation to deliver tumoricidal doses to cancer while limiting dose to surrounding normal tissues. There are several techniques of radiotherapy including external beam therapy and brachytherapy. Factors like total radiation dose, chemotherapy combination, treatment delays and interruptions can influence effectiveness. Complications include both early side effects like mucositis and late effects like osteoradionecrosis. Advances in radiotherapy techniques aim to improve targeting accuracy and reduce side effects.
This study evaluated the outcome of surgical treatment of osteonecrosis of the jaw (ONJ) with the additional use of autologous platelet-rich fibrin (PRF) membranes. 15 patients underwent surgical resection of necrotic bone followed by placement of multiple PRF membrane layers over the bone. At follow-up between 7-20 months post-op, 14 of 15 patients (93%) showed complete mucosal healing with no symptoms or bone exposure, indicating the PRF membranes aided in wound healing. One patient had recurrence. The study concluded PRF membrane use provides multilayer closure and benefits patients with reduced complications and better healing.
Osteomyelitis is an inflammatory condition of bone that usually begins as an infection of the bone marrow. It can spread rapidly through the bone tissue. There are several classifications of osteomyelitis including acute vs chronic forms and suppurative (pus-forming) vs non-suppurative. Common causes include spread from nearby infected tissues, trauma or surgery, or hematogenous spread from other infections. Staphylococcus aureus is a common cause. Imaging like x-rays, CT and MRI can help identify bone changes. Treatment involves antibiotics, sometimes implanted directly into the bone, along with surgical drainage or debridement of infected tissues.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
Naso orbito ethmoid (noe) complex fracture
1. Naso Orbito Ethmoid (NOE)
Complex Fracture
Presented by : Sailesh Kumar. R
PG Trainee
2. •Dawson and Fordyce coined the term " fracture of the
ethmoids" to denote an injury more severe than a
simple nasal fracture.
• Converse and Smith used the term “naso-orbital”.
•Stranc preferred the term “naso-ethmoid”.
• In 1973 Epker coined the term "naso-orbito-ethmoid“,
(NOE) the most popular term in use today."
Evolution of the term NOE
3. •Manson et al have used two terms for these injuries;
"naso-orbital-ethmoid" and "nasoethmoid orbital”.
•Gruss has also used the term "nasoethmoid- orbital”.
•Ian Jackson used the term "orbitoethmoid," believing
that the orbital component needed to be stressed in
these injuries because it accounted for the most
difficult complications."
5. • The medial canthal
tendon arises from the
anterior and posterior
lacrimal crests and the
frontal process of the
maxilla.
• The medial canthal
tendon surrounds the
lacrimal sac and diverges
to become the orbicularis
oculi muscle, tarsal
plate, and suspensory
ligaments of the eyelids.
MEDIAL CANTHAL
TENDON
7. DEFINITION of NOE Fracture
The naso orbito ethmoidal
(NOE) fracture refers to injuries
involving the area of
confluence of the
• nose, orbit, ethmoids,
• the base of the frontal
sinus and
• the floor of the anterior
cranial base.
• The area includes the
insertion of the medial
canthal tendon(s)
10. CLASSIFICATION
Type 1
Unilateral
Bilateral
Type 2
Unilateral
Bilateral
Type 3
Unilateral
Bilateral
Markowitz and Manson
classification (1991)
*Management of medial canthal tendon in nasoorbital ethmoid fractures: In importance of the central
fragment in classification and treatment.
Markowitz et al, plastic and reconstructive surgery,1991, vol 87
11. In unilateral Markowitz type I
fractures, there is a single large NOE
fragment bearing the medial canthal tendon.
Markowitz type I
Bilateral Markowitz type I
fractures,
12. In unilateral type II fractures, there is often
comminution of the NOE area, but the canthal
tendon remains attached to a fragment of
bone, allowing the canthus to be stabilized with
wires or a small plate on the fractured
segment.
Bilateral type II fracture with nasal bone
involvement
The illustration shows a bilateral NOE type II
fracture. In bilateral fractures the nasal bones are
commonly involved. In some instances, bone
grafting of the nasal dorsum may be necessary.
Markowitz type II
13. In unilateral type III fractures,
there is often comminution of the
NOE area (as in type II fractures) and
a detachment of the medial canthal
tendon from the bone.
Bilateral type III fracture with nasal
bone involvement
The illustration shows a bilateral NOE type
III fracture. The nasal bones are usually
involved. Bone graft of the nasal dorsum is
usually necessary.
Markowitz type III
14. Signs and Symptoms
• Decreased dorsal nasal projection
• Upturned nasal tip (pig snout)
• Periorbital ecchymosis and oedema
• Epistaxis
• CSF rhinorrhoea
• Epiphora
• Anosmia
• Nasal airway obstruction
• Traumatic telecanthus
• Traumatic hypertelorism
• Orbital dystopia
Type 1 &
Type 2
Type 3
15. Evaluation of intercanthal distance
Clinical
examination
Ideal nasofrontal angle – 115
to 130 degrees
Ideal nasal projection is 1:1 • Average intercanthal
distance – 28 to 35mm
(differ with Race)
• Found to be half the value
of interpupillary distance
• Evaluate pre injury photos
16. Clinical
examination
• Bimanual palpation using
Kelly clamp
• Determines whether the
canthal-bearing bone
fragment is displaced and
mobile
Furnas traction test/ Bow string test/
Eyelash traction test
Evaluating Crepitus
CSF Leakage
17. Examination of the Eye should also be done along with NOE examination
A study reported by Holt et al, 67% of 727
patients with facial fractures sustained some
degree of ocular injury
19. Management of NOE fractures
• NOE fractures are best treated by open reduction and internal fixation (
Dingman and Natvig 1964)
• Mustarde(1966) described an open technique for restoration of the
displaced medial canthal ligament by transnasal wiring
• This fracture is better overtreated than undertreated because the
secondary deformities (soft tissue retraction, scarring, malposition and
displaced bony fragments) that accompany inadequate therapy are
extremely difficult to correct
• Major reason for treating NOE fracture is esthetics
20. 1.Surgical exposure
2.Identification of the medial canthal tendon and
tendon-bearing bone fragment,
3. Reduction and reconstruction of the medial orbital
rim,
4.Reconstruction of the medial orbital wall,
5.Transnasal canthopexy,
6. Reduction of septal fractures,
7. Nasal dorsum reconstruction and augmentation,
8. Soft tissue adaptation
Eight key steps in the sequencing of NOE fractures by
Ellis
* Sequencing Treatment for Naso-orbito-ethmoid Fractures
EDWARD ELLIS III , JOMS 1993
21. Approaches
• Existing Lacerations
• Local incision
• Coronal incision
• Open Sky Approach (Converse &
Hogan,1970)
• Lynch incision/ Medial canthal
incision
• Midface Degloving incision
• Combination of coronal and lower
lid incisions
• Extended Glabellar approach
(Horizontal Y approach)
22. Surgical landmarks along the dissection of
the medial orbital wall are the:
•Anterior lacrimal crest
•Anterior ethmoidal artery (15 mm from the
crest)
•Posterior ethmoidal artery (25 mm from the
crest)
Pitfall:To avoid injury to the optic nerve
Dissection should stop at the posterior
ethmoidal artery in order not to endanger the
optic nerve at the optic foramen (located at
about 35-40 mm from the crest)
23. Extended Glabellar approach
(Horizontal Y approach)
• The incision should be planned in the glabellar furrows or, if appropriate, in the
region camouflaged by the bridge of eyeglasses.
• The incision is then extended from the lateral nasal bridge to about 3 mm
medial to the skin edge of the caruncle.
• From there it bifurcates into an upper and lower eyelid incision.
• These two extensions can be taken up to the midline of the globe.
Wide visualization of
• medial canthal area,
• lacrimal sac, and
• medial orbital wall
24. Midfacial degloving approach
The horseshoe type bilateral maxillary vestibular
incision is combined with a circumferential incision
(intercartilaginous, transfixion, and nasal floor)
inside both nostrils.
This enables lifting the soft-tissue envelope all the
way up to the nasal dorsum, radix and ethmoid
region.
Access area is extended cranially into the nasal
dorsum and ethmoid area as well as the entire
zygomatic body and the lower portion of lateral
orbital rim
25. The circular endonasal incision and soft-tissue
dissection is achieved using a combination of three
techniques:
•Intercartilaginous incision (A)
•Transfixion incision (B)
•Incision of the nasal floor along the piriform
aperture (C)
After intranasal freeing, the soft-tissue
envelope over the nose and the midface can be
lifted in a subperiosteal and subperichondrial
plane all the way up into the ethmoid region.
26. Coronal approach
Access areas
Entire calvarial vault
•Anterior and lateral skull base
•Frontal sinus/Ethmoid
•Zygoma
•Zygomatic arch
•Orbit (lateral/cranial/medial)
•Nasal dorsum
•Temporomandibular joint (TMJ)
•Condyle and subcondylar region
27. Lower lid incision - Transcutaneous
There are three basic approaches through the
external skin of the lower eyelid to give access to
the inferior, lower medial, and lateral aspects of
the orbital cavity:
•Subciliary (A, synonym: lower blepharoplasty)
•Subtarsal (B, synonym: lower or mideyelid)
•Infraorbital (C, synonym: inferior orbital rim)
The subciliary approach can be extended laterally
to gain access to the lateral orbital rim (D).
Hypertrophic scarring and keloid formation is very
uncommon following lower lid skin incisions. In
general, the scars become inconspicuous with
time.
30. Open Reduction and Internal Fixation
• Disimpaction done by –
Asch’s forceps
• Requires 3-point
exposure and
fixation.
31. Medial canthus fixation- Trans nasal canthopexy
4th plate is needed to support the transnasal
wire
32.
33. The upper illustration represents a wire that has
been placed anteriorly, resulting in a further lateral
splaying of the bone supporting the medial
canthus, and a worsening of the telecanthus.
The lower illustration represents the proper
posterior placement of the transnasal wire with a
proper reduction of the bone attached to the
medial canthus.
Proper position of Transnasal wiring
36. Bilateral NOE fracture with nasal bone involvement
With bilateral displacement of the two
canthal ligaments are wired
transnasally to each other.
37. • Bone grafting done to
augment the dorsum of
nose and also bone grafting
can be done in medial
orbital wall fracture ( using
calvarial / rib graft)
• Bolsters are placed to
prevent edema and
maintain graft in position
38. Post operative management
• Nose-blowing should be avoided for at least 10 days following NOE fracture
repair.
• Medications - Ophthalmic ointment, Steroids, Antibiotics and analgesics
• Ophthalmological Examination
• Vision
• Extraocular motion (motility)
• Diplopia
• Globe position
• Visual field test
• Lid position
• If the patient complains of epiphora (tear overflow), the lacrimal duct must be
checked
• If the patient complains of eye pain, evaluate for corneal abrasion
• Periodic monitoring of globe position, vision and nasal airway obstruction
39. Evaluating the patency of lacrimal apparatus
post operatively
• Dye test – flouriscin dye used
• Jones test I & II
• Direct
• Indirect
• Dacrocystography – lacrimal system is injected with contrast and the
midface is scanned by CT (Ashenhurst et al)
Differential diagnosis of Epiphora:
• Aging, with resultant pulling away from the puncta,
• Paralysis of CN VII,
• Disruption of the medial canthal ligament, and
• Obstruction of hasner’s valve
40. Dacrocystorhinotomy (DCR)
• DCR is done to bypass the nasolacrimal duct by
anastomosing the lacrimal sac with the nasal
mucosa.
41. The sac is dissected free from its bony
attachments and the bony ostium is
made medial to the lower part of the
sac with a 10-mm trephine bur.
The lacrimal bone and part of the
anterior lacrimal crest are removed.
The posterior nasal and sac flaps are
sutured, as are the corresponding
anterior flaps.
Hollwich has modified – that the
anterior mucosal flap of the sac is
sutured to the overlying subcuticular
skin.
42.
43. • The nasal bone opening must be large enough, its borders must be
smooth so that granulomas do not form, and daily lavage with
Ringer’s solution should be started on the postoperative day 2 and
continued for approximately 4 weeks.
• DCR usually can be performed safely 3 to 4 months after the initial
reconstruction if the lacrimal obstruction was initially left unnoticed
44. References
• AO Foundation. “Nasal/NOE”. https://www2.aofoundation.org
• Rowe and Williams’ Maxillofacial Injuries
• Fonseca walker, 4th ed
• Management of medial canthal tendon in nasoorbital ethmoid fractures: In importance
of the central fragment in classification and treatment. Markowitz et al, plastic and
reconstructive surgery,1991, vol 87
• Sequencing Treatment for Naso-orbito-ethmoid Fractures , EDWARD ELLIS III , JOMS
1993
• Grays Anatomy, 40th ed
*