MIDDLE-THIRD FRACTURES

FRACTURES THAT DO NOT INVOLVE CHANGES OF OCCLUSION

NASAL BONE FRACTURES

Nasal bone fractures are the most common because the nose is more exposed and consists of thin bones. Nose fracturing is usually followed by swelling, deformation and pain on touch. There may be nosebleeds and associated bruises.

FRACTURES OF THE NASO-ORBITO-ETHMOIDAL COMPLEX

These are complex fractures that, in addition to the ensuing aesthetic deformity, are often associated with important injuries of the skull base, with structural lacerations. The lacrimal system is often compromised. The bone structure most often affected is the naso-maxillary pillar.

ORBITO-MALAR FRACTURES

Orbital fractures are complex and can be an emergency if there is herniation of orbital contents into the maxillary sinus.

Two types of fractures are considered:
Unstable, where it is necessary to align and fix the bone fragments

• Stable, that do not require surgical intervention

ORBITAL FLOOR FRACTURES

They can be classified as blowout, trapdoor or blow-in, the first being the most frequent in adulthood.

These fractures may cause aesthetic changes, such as enophthalmos/dystopia, and functional known as diplopia (double vision) and ophthalmoplegia.

As a rule, in these cases reconstructions are performed with PDS implantation, bone graft from skullcap, titanium grid or alloplastic material. In this type of fracture, it is very important to restore the orbital volume (30-35 cm3), always endeavouring to perform some overcorrection in relation to the contralateral orbit.

In trauma/fractures involving the orbit, it is always crucial to assess visual acuity, presence of swelling, ptosis of the upper eyelid and/or ophthalmoplegia, in collaboration with ophthalmology.

FRACTURES OF THE ZYGOMATIC ARCADE

Zygomatic complex fractures may also involve the orbit, and are frequently fractures that can be treated very simply with a Ginestet hook in a minimally invasive manner with good aesthetic and functional results.