اعوجاج الحاجز الانفي وتضخم غضاريف ‏الانف

patient came to the emergency unit of Zagazig university hospital with trauma in motor car accident.
after examination of the patient we found facial trauma and oedema and bruises and depression in the area of Glabella and the nasal pyramid which like telescope and Called telescopic fracture of the naso orbital region and , there was a depression in the frontal area Which seems to be fracture of the anterior wall of the frontal sinus.

we check the rest of the body to Find any hidden injury and Check the patient neck to confirm That his vertebrae had no injury.

we also check the patient mouth and occlusion to avoid missing any Jaw fracture.

the patient was admitted to the hospital and Laboratory  analysis was done to check any abnormality can interfere with the Surgery.

radiological investigations were performed CT scan multislice with multiplanar reformatted were done and axial ' Coronal ' sagittal ' cutts were taken and also 3D.

the CT Scan showed naso-ethmoid orbital fracture with telescopic depression of the nasal bridge and nasal radix with frontal Sinus anterior Wall fracture with depression in the Frontal region.

the patient was prepared for maxillofacial Surgery to fix this fracture .

our approach in this fracture was the bicoronal approach to avoid Scar in the frontal Skin and to get a good exposure to the area of the frontal bone and naso orbital area.

after elevating the frontal flap based on orbital and Trochlear arteries then We incise the pericranial and elevate a pericranial flap to Cover the fixated area at the end of the operation .

we made a template of the frontal bone anterior table of the frontal sinus from radiological paper X. Ray of the patient Skull in the water view .

we cut the frontal bone which depressed by small Osteotome and elevated the depressed Segment and fixed by micro plates and screws made of titanium and the telescopic fractured naso ethmoid orbital fracture was elevated also and fixed to the frontal bone by micro plates and screws.

the pericranial flap Covered the fractured bone and the bicronal flap returned to its position and Sutured by vicryl head bandage and drain were applied and removed after one week and 3 days respectively .