Fractures of the naso-orbital-ethmoid (NOE) region tend to be complex injuries requiring extensive reparative surgical procedures.


Occurrence: high energy trauma impacting the central midface, typically in a high speed vehicular accident


Clinical signs and symptoms:

(1) facial flattening (best viewed from above or below) due to collapse of facial buttresses

(2) traumatic telecanthus (abnormal increase in the distance between the medial canthi)

(3) damage to the nasolacrimal system

(4) epistaxis, CSF rhinorrhea and/or anosmia

(5) signs and symptoms of associated fractures (LeFort I-III, orbit, other)

(6) traumatic optic neuropathy or optic canal fracture

(7) ocular trauma

(8) brain injury, often with coma


Causes of mortality:

(1) vascular damage

(2) airway obstruction

(3) brain damage

(4) infection


Management consists of imaging studies to define the extent of injury followed by early surgery by a multi-specialty team.


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