Naso-orbitoethmoid (NOE) complex fracture
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View Dalia Ibrahim's current disclosures- NOE complex fractures
- Nasoethmoidal complex fractures
- Orbitoethmoid fractures
Naso-orbitoethmoid (NOE) fractures, also known as orbitoethmoid or nasoethmoidal complex fractures, involve the central upper midface.
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Pathology
Naso-orbitoethmoid fractures are caused by a high-impact force applied anteriorly to the nose and transmitted posteriorly through the ethmoid bone.
Associations
Associated injuries include:
telecanthus secondary to medial canthal tendon injury
nasolacrimal duct disruption and subsequent frontal mucocele formation
orbital injuries and exophthalmos due to reduced intra-orbital volume
cerebrospinal fluid rhinorrhea due to fracture through the cribriform plate
epiphora secondary to nasolacrimal duct injury
Classification
The Markowitz and Manson classification system is commonly used to classify NOE complex fractures 3.
Radiographic features
Comminution of both nasomaxillary buttresses results in a pattern of fractures involving the nasal bones and septum, ethmoid sinuses, and medial orbital walls.
Quiz questions
Question 2123
A CT report for facial trauma contains the following findings: "There is a mildly comminuted fracture involving the left frontal process of the maxilla and left nasal bone. Fracture lines in this region extend from the pyriform aperture across the medial maxillary buttress to the left inferior orbital rim, sparing the infraorbital canal. However, minimally displaced fractures involve the medial third of the orbital floor, internal orbital buttress, and the lamina papyracea. There is less than 0.5 mm outward herniation of extraconal fat into the ethmoid labyrinth. One of the fracture lines extends anteriorly to the frontomaxillary suture, liberating a minimally displaced fragment of bone containing the lacrimal fossa, which appears intact. The left lateral orbital wall is intact. There is a fracture of the medial wall of the maxillary sinus but not the lateral wall."
What classification best summarizes the most significant injuries?
References
- 1. Winegar B, Murillo H, Tantiwongkosi B. Spectrum of Critical Imaging Findings in Complex Facial Skeletal Trauma. Radiographics. 2013;33(1):3-19. doi:10.1148/rg.331125080 - Pubmed
- 2. Hopper R, Salemy S, Sze R. Diagnosis of Midface Fractures with CT: What the Surgeon Needs to Know. Radiographics. 2006;26(3):783-93. doi:10.1148/rg.263045710 - Pubmed
- 3. 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
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