Clinical Features of Naso-Orbital-Ethmoid (NOE) Fractures of the Central Midface

 

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.