Naso-Orbito-Ethmoid Fractures

Excerpt

Fractures of the naso-orbito-ethmoid (NOE) complex involve the bones that form the NOE confluence, including the anterior cranial fossa, the frontal bone, the bones of the ethmoid and frontal sinuses, the nasal bones, and the orbits. These injuries often occur concurrent with injuries to other parts of the face and body but can also occur in isolation. Road traffic accidents and interpersonal violence are the leading causes of these injuries, but this picture is changing with improving vehicle and road safety.

Knowledge of regional anatomy is fundamental to understanding the assessment and management of NOE fractures. The approach to patients with these injuries begins with the advanced trauma life support algorithm. These patients may also have injuries to critical structures such as the airway, the brain, and the cervical spine. Further evaluation relies on a thorough clinical assessment aided by radiological imaging. Any operative intervention will depend on the classification of the NOE complex fracture, which is based on the status of the medial canthal tendon. Meticulous primary surgical correction is the key to the aesthetic restoration of the facial features and prevention of future complications. The operative approach and exposure must balance the need to correct any deformities while avoiding further cosmetic disruption.