American Association of Plastic Surgeons

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Underdiagnosis of Nasoorbitoethmoid Fractures in Patients with Midface Trauma
Nicholas J. Nissen, B.A.1, Sun Hsieh, M.D.2, Vinay Rao, M.D.2, Albert Woo, M.D.2.
1The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Department of Plastic and Reconstructive Surgery, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.

PURPOSE: Nasoorbitoethmoid (NOE) fractures commonly accompany midface fractures and are often undiagnosed, resulting in incomplete reconstruction. The purpose of this study is to analyze NOE fracture concomitance with zygoma fractures in order to better understand NOE fracture diagnosis and treatment tendencies.
METHODS: The plastic surgery facial trauma database at a level 1 trauma center was evaluated. All patients with diagnosed zygoma fractures from 07/2011-03/2016 were assessed for a concomitant NOE injury. Rate of documentation of NOE fractures in radiology, plastic surgery, and operative notes was recorded as well as rate of NOE surgical correction.
RESULTS: We identified 339 eligible patients and completed retrospective analysis of CT images for their 356 zygoma fractures. The incidence of concomitant NOE fractures was 30.6% (109/356). 0% of NOE fractures were mentioned in radiology notes, 1.8% in plastic surgery notes, and 8.3% in operative notes. 22.9% (25/109) of NOE fractures were surgically corrected. 44.9% (49/109) of all NOE fractures were minimally-displaced.
Subset analysis of significantly-displaced NOE fractures yielded an incidence rate of 16.8% (60/356). Of these, 0% were mentioned in radiology notes, 9.1% in plastic surgery notes, and 20.4% in operative notes. 31.7% (19/60) of significantly-displaced NOE fractures were surgically corrected.
CONCLUSION: These findings suggest a high concomitance of NOE fractures with zygoma fractures as well as a tendency to under-document and under-treat NOE fractures. Radiologists should be trained in identifying NOE fractures. Clinicians treating patients with midface trauma should have a high suspicion for NOE injury.


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