ABSTRACT

It is recognised that the meticulous reduction and stabilisation of the canthal ligament or the canthus-bearing bony segment is the key to successful restoration of the pre-trauma facial appearance. For the required surgical exposure, it is still advised to combine a superior exposure by way of a coronal approach with a lower local approach in cases with comminution and displacement. The transconjunctival approach with a possible trans-caruncular extension has gained popularity. Nevertheless, skin incisions are still promoted. The usefulness of the different approaches is dependent on the presence of lacerations and the particular area that needs to be reached for fixation. In conclusion, over 25 years after publication, the Markowitz classification has been proven to be very useful in determining the severity of the fracture and is still the basis for diagnostic classification of naso-orbital-ethmoid fractures. The proposed treatment strategy cannot be correlated with outcome, and therefore many modifications have been published since.