eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma
Nasoorbitoethmoid Fractures: Workup
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.
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Workup: Nasoorbitoethmoid Fractures |
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| References |
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References
Sargent LA. Nasoethmoid orbital fractures: diagnosis and treatment. Plast Reconstr Surg. Dec 2007;120(7 Suppl 2):16S-31S. [Medline].
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].
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].
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].
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].
Hoffmann JF. Naso-orbital-ethmoid complex fracture management. Facial Plast Surg. 1998;14(1):67-76. [Medline].
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].
Leipziger LS, Manson PN. Nasoethmoid orbital fractures. Current concepts and management principles. Clin Plast Surg. Jan 1992;19(1):167-93. [Medline].
Sargent LA, Rogers GF. Nasoethmoid orbital fractures: diagnosis and management. The Journal of Cranio-Maxillofacial Trauma. 1999;5(1):19-27.
Further Reading
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
Workup: Nasoorbitoethmoid Fractures