Naso-orbitoethmoid (NOE) complex fracture
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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
orbital injuries and exophthalmos due to reduced intra-orbital volume
epiphora secondary to nasolacrimal duct injury
Comminution of both nasomaxillary 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 categorizes 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