2. Nasal-Orbital-Ethmoid (NOE)
Fractures
Usually not isolated event
Frequently associated with
multiple midface fractures
Secondary to traumatic insult
to radix area of nose
Low resistance to directional
force
only 35-80 gm necessary to
produce fracture
12/28/2020 Dr.Simon Rock
3. Naso-Ethmoidal-Orbital
Fracture
Fractures that extend into the
nose through the ethmoid bones.
Associated with lacrimal
disruption and dural tears.
Suspect if there is trauma to the
nose or medial orbit.
Patients complain of pain on eye
movement.
12/28/2020 Dr.Simon Rock
4. Nasal-Orbital-Ethmoid
Fractures
Diagnosis
Ophthalmalogic evaluation
Document visual acuity
Pupillary response to light
Neurologic evaluation
Frontal lobe contusion
Glasgow coma scale
Increase in ICP and need for monitoring
12/28/20
20
Dr.Simon Rock
5. Naso-Ethmoidal-Orbital
Fracture
Clinical findings:
Flattened nasal bridge or a saddle-shaped deformity of the
nose.
Widening of the nasal bridge (telecanthus)
CSF rhinorrhea or epistaxis.
Tenderness, crepitus, and mobility of the nasal complex.
Intranasal palpation reveals movement of the medial
canthus.
12/28/20
20
Dr.Simon Rock
6. Nasal-Orbital-Ethmoid Fractures
Traumatic telecanthus
Difficult to measure due to
edema
Average 33-34 mm
Can measure interpupillary
distance and divide in half for
approximate intercanthal
distance
Average 60-65 mm
Damage to lacrimal
apparatus-epiphora
CSF leak
12/28/2020 Dr.Simon Rock
8. Nasal-Orbital-Ethmoid
Fractures Lacrimal system injury
When the medial canthal ligament has been injured or displaced, damage
to the lacrimal system should be assumed
Nasolacrimal duct is often damaged within its bony course
Epiphora: Need to evaluate patency of the nasolacrimal system
12/28/20
20
Dr.Simon Rock
10. Nasal-Orbital-Ethmoid Fractures
Radiographic examination
CT - definitive imaging
modality
Axial images supplemented
with coronal
Plain films to fail demonstrate
the degree and location of
fractures secondary to over-
lapping of bony archi- tecture
12/28/2020 Dr.Simon Rock
12. Nasal-Orbital-Ethmoid Fractures
Surgical considerations
Definitive surgery as soon
as possible after:
Appropriate consultations
Definitive radiographic
imaging
Significant edema allowed to
resolve
12/28/2020 Dr.Simon Rock
13. Nasal-Orbital-Ethmoid
Fractures
Surgical considerations
In panfacial trauma The final phase involves
reduction of the NOE and nasal bone fractures
Access to NOE through
existing lacerations,
bicoronal flap, or
local incisions
12/28/20
20
Dr.Simon Rock
16. Nasal Fractures
Most common of all facial fractures.
Injuries may occur to other surrounding bony structures.
3 types:
Depressed
Laterally displaced
Nondisplaced
12/28/20
20
Dr.Simon Rock
21. Nasal Fractures
Treatment
Restoration of form and
function
Proper reduction of
nasal fracture
Plaster splint
Correction of lacrimal
system injuries
12/28/2020 Dr.Simon Rock
22. Frontal Sinus/ Bone Fractures
Pathophysiology
Results from a direct blow to the frontal bone with blunt object.
Associated with:
Intracranial injuries
Injuries to the orbital roof
Dural tears
12/28/20
20
Dr.Simon Rock
23. Frontal Sinus/ Bone Fractures
Clinical Findings
Disruption or
crepitance orbital
rim
Subcutaneous
emphysema
Associated with a
laceration
12/28/2020 Dr.Simon Rock
24. Frontal Sinus/ Bone Fractures
Diagnosis
Radiographs:
Facial views should
include Waters,
Caldwell and lateral
projections.
Caldwell view best
evaluates the anterior
wall fractures.
12/28/2020 Dr.Simon Rock
25. Frontal Sinus/ Bone Fractures
Diagnosis
CT Head with bone
windows:
Frontal sinus
fractures.
Orbital rim and
nasoethmoidal
fractures.
12/28/2020 Dr.Simon Rock
26. Frontal Sinus/ Bone Fractures
Treatment Patients with depressed skull fractures
or with posterior wall involvement.
nuerosurgery consultation.
Admission.
IV antibiotics.
Tetanus.
Patients with isolated anterior wall
fractures, nondisplaced fractures can
be treated outpatient after
consultation with neurosurgery.
12/28/20
20
Dr.Simon Rock
27. Frontal Sinus/ Bone Fractures
Complications Associated with intracranial injuries:
Orbital roof fractures.
Dural tears.
Epidural empyema.
CSF leaks.
Meningitis.
12/28/20
20
Dr.Simon Rock
