Naso-ethmoid fracture
Background
- Also known as naso-orbito-ethmoid (NOE) fracture
- Results from high-energy direct impact to nasal bridge
- Involves the nasal bones, ethmoid sinuses, medial orbital walls, and frontal process of maxilla
- Medial canthal ligament (MCL) disruption is the key complication
- Associated intracranial injury in up to 70% of cases
Clinical Features
- Flattened nasal bridge, telecanthus (increased intercanthal distance >35mm)
- Periorbital ecchymosis, edema
- Epistaxis
- Epiphora (tearing) from lacrimal apparatus disruption
- CSF rhinorrhea if cribriform plate/dura involved
- Bowstring test: Pull lateral canthus laterally; if medial canthus moves freely, MCL is disrupted
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- CT face with thin cuts through orbits and ethmoid — gold standard
- Bimanual palpation: hemostat intranasally while palpating medial orbital rim externally for crepitus
- Evaluate for CSF leak (halo test, beta-2 transferrin)
- Ophthalmology assessment for globe injury
Management
- Avoid nasotracheal intubation and NG tubes if cribriform plate disrupted
- Control epistaxis with anterior packing
- Antibiotics if open fracture or CSF leak
- Definitive repair by ENT/facial surgery (often delayed 5-7 days for edema)
Disposition
- Admit for associated injuries (intracranial, orbital)
- ENT/maxillofacial surgery and neurosurgery consults as indicated