Open treatment of nasoethmoid fracture; with external fixation
CPT4 code
Name of the Procedure:
Open Treatment of Nasoethmoid Fracture; with External Fixation
Common name(s): Open Reduction and External Fixation (OREF) of Nasoethmoid Fracture, NOE Fracture Fixation
Summary
In this surgical procedure, the fractured bones in the nasoethmoid complex (area around the nose and the ethmoid bone) are realigned (reduced) and secured (fixed) using external hardware. This method involves making an incision to access the fracture site, aligning the bones, and placing external fixation devices to hold the bones in the correct position as they heal.
Purpose
The procedure addresses fractures of the nasoethmoid complex, which can result from trauma to the face. Goals include:
- Restoring normal facial structure and symmetry
- Ensuring proper function of the nasal and sinus regions
- Preventing complications such as infection, irregular healing, or persistent facial deformity
Indications
- Nasoethmoid fractures confirmed by clinical evaluation and imaging
- Facial trauma with noticeable distortion and displacement of facial bones
- Difficulty breathing through one or both nostrils due to the fracture
- Cosmetic concerns due to facial asymmetry caused by the fracture
Preparation
- Patients may need to fast for 8-12 hours before surgery.
- Preoperative imaging studies, such as CT scans, are necessary to assess the extent of the fractures.
- Blood tests and a full medical evaluation to ensure the patient is fit for surgery.
- Medication adjustments: blood thinners may need to be paused.
- Arrangements for postoperative support and transportation.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A surgical incision is made to access the fractured area.
- Reduction: The fractured bones are carefully manipulated back into their correct positions.
- Fixation: External fixation devices such as pins, screws, and rods are applied to stabilize the bones.
- Closure: The incision is closed with sutures, and the external fixation frame is adjusted to maintain alignment.
Duration
The procedure typically takes 2-4 hours, depending on the complexity of the fracture.
Setting
The operation is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeons specialized in facial and reconstructive surgery
- Anesthesiologists to administer and manage anesthesia
- Surgical nurses and technicians to assist during the procedure
Risks and Complications
- Infection at the incision or fixation sites
- Bleeding or hematoma formation
- Scarring or numbness at the incision site
- Risks associated with general anesthesia
- Potential for nonunion or malunion of the fracture
- Need for additional surgery if fixation becomes loose or misaligned
Benefits
- Restored facial symmetry and function
- Reduced risk of chronic issues related to untreated fractures
- Improved cosmetic appearance and self-esteem
- Proper healing and quicker return to normal activities
Recovery
- Pain management with prescribed medications
- Instructions for wound care and keeping the fixation clean
- Avoiding strenuous activities for several weeks
- Regular follow-up appointments to monitor healing and adjust fixation devices as needed
- Estimated recovery time: 6-8 weeks for initial bone healing, with full recovery taking several months.
Alternatives
- Closed reduction with internal fixation, which doesn't use external devices
- Non-surgical management with observation and supportive care for minor fractures
- Pros: Less invasive and may have shorter recovery times.
- Cons: May not be suitable for complex fractures and might not restore full function or appearance.
Patient Experience
- Variable pain levels managed by medication
- Sensation of hardware temporarily fixed outside facial skin
- Swelling and bruising, which typically subside in a few weeks
- Regular visits for adjustment and monitoring by the surgical team
- Gradual improvement in facial appearance and function as healing progresses