eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Nasoorbitoethmoid Fractures: Multimedia

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

Multimedia

A diagram of the nasoorbitoethmoid complex is sho...Media file 1: A diagram of the nasoorbitoethmoid complex is shown. Note that the cribriform plate descends approximately 1 cm below the level of the ethmoid roof (fovea ethmoidalis).
A diagram of the nasoorbitoethmoid complex is sho...

A diagram of the nasoorbitoethmoid complex is shown. Note that the cribriform plate descends approximately 1 cm below the level of the ethmoid roof (fovea ethmoidalis).

Vertical buttresses of the nasoorbitoethmoid comp...Media file 2: Vertical buttresses of the nasoorbitoethmoid complex are depicted.
Vertical buttresses of the nasoorbitoethmoid comp...

Vertical buttresses of the nasoorbitoethmoid complex are depicted.

Horizontal buttresses of the nasoorbitoethmoid co...Media file 3: Horizontal buttresses of the nasoorbitoethmoid complex are depicted.
Horizontal buttresses of the nasoorbitoethmoid co...

Horizontal buttresses of the nasoorbitoethmoid complex are depicted.

Anatomy of the medial canthal tendon is shown. Th...Media file 4: Anatomy of the medial canthal tendon is shown. The tendon splits around the lacrimal sac and attaches to the anterior and posterior lacrimal crests, as well as to the frontal process of the maxilla. The canthal tendon diverges to become the pretarsal, preseptal, and orbital orbicularis oculi muscle.
Anatomy of the medial canthal tendon is shown. Th...

Anatomy of the medial canthal tendon is shown. The tendon splits around the lacrimal sac and attaches to the anterior and posterior lacrimal crests, as well as to the frontal process of the maxilla. The canthal tendon diverges to become the pretarsal, preseptal, and orbital orbicularis oculi muscle.

Midface dimensions are depicted. A normal interca...Media file 5: Midface dimensions are depicted. A normal intercanthal distance is 30-35 mm, which is approximately half of the interpupillary distance and is equivalent to the width of the nasal base.
Midface dimensions are depicted. A normal interca...

Midface dimensions are depicted. A normal intercanthal distance is 30-35 mm, which is approximately half of the interpupillary distance and is equivalent to the width of the nasal base.

Nasoorbitoethmoid complex fractures are classifie...Media file 6: Nasoorbitoethmoid complex fractures are classified according to 3 types. (A) Type I fractures involve a single, noncomminuted, central fragment without medial canthal tendon disruption (left-unilateral, right-bilateral). (B) Type II fractures involve comminution of the central fragment without medial canthal tendon disruption (left-unilateral, right-bilateral). (C) Type III fractures result in severe central fragment comminution with medial canthal tendon disruption (left-unilateral, right-bilateral).
Nasoorbitoethmoid complex fractures are classifie...

Nasoorbitoethmoid complex fractures are classified according to 3 types. (A) Type I fractures involve a single, noncomminuted, central fragment without medial canthal tendon disruption (left-unilateral, right-bilateral). (B) Type II fractures involve comminution of the central fragment without medial canthal tendon disruption (left-unilateral, right-bilateral). (C) Type III fractures result in severe central fragment comminution with medial canthal tendon disruption (left-unilateral, right-bilateral).

Axial CT scan demonstrates a comminuted nasoorbit...Media file 7: Axial CT scan demonstrates a comminuted nasoorbitoethmoid complex fracture.
Axial CT scan demonstrates a comminuted nasoorbit...

Axial CT scan demonstrates a comminuted nasoorbitoethmoid complex fracture.

Illustration depicts the fascial planes of the fo...Media file 8: Illustration depicts the fascial planes of the forehead and temple. The temporal branch of the facial nerve runs within the superficial temporal fascia (temporoparietal fascia).
Illustration depicts the fascial planes of the fo...

Illustration depicts the fascial planes of the forehead and temple. The temporal branch of the facial nerve runs within the superficial temporal fascia (temporoparietal fascia).

Illustration depicts the subciliary approach to t...Media file 9: Illustration depicts the subciliary approach to the orbital floor and nasoorbitoethmoid complex.
Illustration depicts the subciliary approach to t...

Illustration depicts the subciliary approach to the orbital floor and nasoorbitoethmoid complex.

(Above) Transnasal wires placed anterior to the l...Media file 10: (Above) Transnasal wires placed anterior to the lacrimal fossa result in rotation of the central fragment laterally, which results in postoperative telecanthus. (Below) Transnasal wires placed posterior and superior to the lacrimal fossa provide adequate support for the medial canthal tendon, and postoperative telecanthus is avoided.
(Above) Transnasal wires placed anterior to the l...

(Above) Transnasal wires placed anterior to the lacrimal fossa result in rotation of the central fragment laterally, which results in postoperative telecanthus. (Below) Transnasal wires placed posterior and superior to the lacrimal fossa provide adequate support for the medial canthal tendon, and postoperative telecanthus is avoided.

Reconstruction of nasal dorsum with cantilevered ...Media file 11: Reconstruction of nasal dorsum with cantilevered calvarial bone graft is shown.
Reconstruction of nasal dorsum with cantilevered ...

Reconstruction of nasal dorsum with cantilevered calvarial bone graft is shown.

More on Nasoorbitoethmoid Fractures

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

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.

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

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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