Complex nasoethmoid-orbital and midfacial fractures: role of craniofacial surgical techniques and immediate bone grafting.

A detailed review of 104 patients with severe nasoethmoid-orbital injuries has facilitated the classification of these injuries into five types. The recognition and diagnosis of each specific injury pattern will define the correct treatment choice in each instance. Special attention should be focused on injuries with comminution and bone loss in the medial wall and floor of the orbit, loss of cartilaginous nasal support, and orbital displacement and dystopia. An open, direct approach to these fractures with meticulous reduction, internal fixation, and repair of the medial canthal ligaments provides optimal repair. The use of craniofacial surgical techniques and immediate bone graft replacement of missing or severely damaged bone will allow reconstruction of even the most difficult injuries in one stage. Three hundred and nine primary bone grafts have been used in 66 patients. No significant complications of their use have occurred.