eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Nasoorbitoethmoid Fractures: Workup

Author: Travis T Tollefson, MD, FACS, Assistant Professor, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center
Coauthor(s): E Bradley Strong, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of California at Davis
Contributor Information and Disclosures

Updated: Jul 16, 2009

Workup

Laboratory Studies

  • Beta2-transferrin is the definitive test for CSF rhinorrhea. Collect 1 mL of the suspected fluid in a red top tube. Beta2-transferrin is a "send out" laboratory at most institutions. Watery rhinorrhea that is positive for beta2-transferrin is diagnostic for a CSF leak. Besides CSF, only the vitreous humor of the eye and the perilymph of the ear have been found to contain beta2-transferrin.
  • Bloody rhinorrhea suspicious for CSF can be placed on filter paper and observed for a halo sign. If CSF is present, it diffuses faster than blood and results in a clear halo around the central stain.
  • Routine chemistry analysis of the rhinorrhea may reveal an elevated glucose content consistent with CSF.

Imaging Studies

  • Plain radiographs have limited usefulness in aiding the diagnosis of nasoorbitoethmoid (NOE) fractures.
  • Thin-cut (1.5 mm) axial and coronal (when available) CT scans are the criterion standard for the diagnosis of NOE fractures (see Image 7).
    • Axial images reveal injury to the frontal sinus, lamina papyracea, ethmoid complex, nasal septum, and nasal bones.
    • Coronal images detail injuries to the cribriform plate, nasofrontal recess, orbital roof and floor, and lamina papyracea.
    • Contrast enhancement of the CSF can assist with the diagnosis of CSF fistula.

More on Nasoorbitoethmoid Fractures

Overview: Nasoorbitoethmoid Fractures
Workup: Nasoorbitoethmoid Fractures
Treatment: Nasoorbitoethmoid Fractures
Follow-up: Nasoorbitoethmoid Fractures
Multimedia: Nasoorbitoethmoid Fractures
References
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References

  1. Sargent LA. Nasoethmoid orbital fractures: diagnosis and treatment. Plast Reconstr Surg. Dec 2007;120(7 Suppl 2):16S-31S. [Medline].

  2. 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. May 1991;87(5):843-53. [Medline].

  3. Cultrara A, Turk JB, Har-El G. Midfacial degloving approach for repair of naso-orbital-ethmoid and midfacial fractures. Arch Facial Plast Surg. Mar-Apr 2004;6(2):133-5. [Medline].

  4. Potter JK, Muzaffar AR, Ellis E, Rohrich RJ, Hackney FL. Aesthetic management of the nasal component of naso-orbital ethmoid fractures. Plast Reconstr Surg. Jan 2006;117(1):10e-18e. [Medline].

  5. Herford AS, Ying T, Brown B. Outcomes of severely comminuted (type III) nasoorbitoethmoid fractures. J Oral Maxillofac Surg. Sep 2005;63(9):1266-77. [Medline].

  6. Hoffmann JF. Naso-orbital-ethmoid complex fracture management. Facial Plast Surg. 1998;14(1):67-76. [Medline].

  7. Hopper RA, Salemy S, Sze RW. Diagnosis of midface fractures with CT: what the surgeon needs to know. Radiographics. May-Jun 2006;26(3):783-93. [Medline].

  8. Leipziger LS, Manson PN. Nasoethmoid orbital fractures. Current concepts and management principles. Clin Plast Surg. Jan 1992;19(1):167-93. [Medline].

  9. Sargent LA, Rogers GF. Nasoethmoid orbital fractures: diagnosis and management. The Journal of Cranio-Maxillofacial Trauma. 1999;5(1):19-27.

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Further Reading

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Keywords

nasoorbitoethmoid fractures, nasoorbitoethmoid complex, NOE, nasoethmoid complex fractures, nasoethmoid fractures, NOE injury, facial injury, panfacial fracture, ethmoid complex, cerebrospinal fluid, CSF, medial canthal tendon, MCT, frontal sinus, ethmoid sinuses, anterior cranial fossa, orbits, frontal bone, nasal bones, telecanthus

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Contributor Information and Disclosures

Author

Travis T Tollefson, MD, FACS, Assistant Professor, Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center
Travis T Tollefson, MD, FACS is a member of the following medical societies: American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Coauthor(s)

E Bradley Strong, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of California at Davis
E Bradley Strong, MD is a member of the following medical societies: Alpha Omega Alpha and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Jack A Coleman, MD, Consulting Staff, Franklin Surgical Associates
Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US
Disclosure: accarent, inc Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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