Naso-orbitoethmoid (NOE) complex fracture
Naso-orbitoethmoid (NOE) fractures (also known as orbitoethmoid or nasoethmoidal complex fractures) are fractures which involve the central upper midface.
Associated injuries include:
- telecanthus secondary to medial canthal tendon injury
- nasofrontal duct disruption and subsequent frontal mucocoele formation
- orbital injuries and exophthalmos due to reduced intra-orbital volume
- cerebrospinal fluid rhinorrhoea due to fracture through the cribriform plate
Comminution of both medial maxillary buttresses results in a pattern of fractures involving the nasal bones and septum, ethmoid sinuses, and medial orbital walls.
The Markowitz and Manson classification system categorises fractures of the NOE complex as follows 3:
- type I: in which 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
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- 3. Markowitz BL, Manson PN, 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. Pubmed citation