Hacking C, Knipe H, Deng F, et al. Markowitz and Manson classification system of naso-orbitoethmoid fractures. Reference article, Radiopaedia.org (Accessed on 26 Mar 2025) https://doi.org/10.53347/rID-42077
Naso-orbitoethmoid fractures: Markowitz and manson classification system
Markowitz sytstem
Markowitz and Manson classifcation
The Markowitz and Manson classification systemof naso-orbitoethmoid (NOE) complex fractures is based on the integrity of the medial canthal ligament and applies to adults.
Usage
The Markowitz and Manson system is commonly used (c. 2024) to classify NOE complex fractures in adults 2; however, it does not account for structural differences (e.g. frontal sinus pneumatization, midface proportions) in children. The Bernstein et al. classification is proposed to be more suitable for paediateric cases 2,3.
Classification
type I: the medial canthal tendon is intact and connected to a single large fracture fragment
type II: the fracture is comminuted, and the medial canthal tendon is attached to a single bone fragment
type III: comminution extends to the medial canthal tendon insertion site on the anterior medial orbital wall at the level of the lacrimal fossa, with resultant avulsion of the tendon
1. Markowitz B, Manson P, Sargent L et al. Management of the Medial Canthal Tendon in Nasoethmoid Orbital Fractures: The Importance of the Central Fragment in Classification and Treatment. Plast Reconstr Surg. 1991;87(5):843-53. doi:10.1097/00006534-199105000-00005 - Pubmed
2. Goh E, Bullis S, Beech N, Johnson N. Surgical Management of Naso-Orbito-Ethmoidal Fractures: A Systematic Review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2024;138(1):9-20. doi:10.1016/j.oooo.2024.02.021 - Pubmed
3. Balaraman K. Frontal and Naso-Orbito-Ethmoid Complex Fractures. Oral and Maxillofacial Surgery for the Clinician. 2021;:1251-66. doi:10.1007/978-981-15-1346-6_58
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