“How To Diagnose NOE (Nasoethmoidal) Fractures?”

Quick Review #85 - #trauma #facialtrauma #fracture #noe #nasoethmoidal #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental Diagnosing nasoethmoidal fractures typically involves a combination of clinical examination and imaging studies. Here’s an overview of the process: 1. Clinical History and Presentation: Patients with nasoethmoidal fractures often present after a high-energy impact to the midface, such as in motor vehicle accidents or falls. Common symptoms include: • Visible deformity of the nasal bridge • Epistaxis (nosebleed) • Periorbital ecchymosis (bruising around the eyes, also known as “raccoon eyes”) • Telecanthus (increased distance between the inner corners of the eyes) • Possible disturbance in vision or diplopia (double vision) • Epiphora (tearing due to nasolacrimal duct involvement) 2. Physical Examination: • Assess for facial asymmetry, deformity, or crepitus. • Check for mobility of the nasal bridge, which might suggest a fracture. • Evaluate the intercanthal distance to see if it’s widened (telecanthus). • Inspect for signs of cerebrospinal fluid (CSF) rhinorrhea, which can occur if the cribriform plate is involved. 3. Imaging: • Computed Tomography (CT) Scan: This is the gold standard for diagnosing nasoethmoidal fractures. A CT scan provides detailed images of bone and can clearly delineate the extent of the fracture, including involvement of the ethmoid labyrinth, cribriform plate, and nasolacrimal duct. 4. Ophthalmologic Evaluation: Given the close proximity to the eyes, patients with suspected nasoethmoidal fractures should have an ophthalmologic evaluation to rule out ocular injuries. 5. Neurological Assessment: In cases with suspected involvement of the cribriform plate or intracranial injury, a neurological assessment may be necessary. 6. Facial Trauma (OMFS, ENT, Plastic Surgery) Consultation: This can be useful for further assessment and management, especially if there’s involvement of the nasolacrimal duct or significant nasal deformity. It’s important to diagnose and manage nasoethmoidal fractures promptly due to the potential for complications, such as infection, persistent deformity, and impaired nasal and lacrimal function. References: 1. Sargent, L. A. (2007). Nasoethmoid orbital fractures: diagnosis and treatment. Plastic and Reconstructive Surgery, 120(7 Suppl 2), 16S-31S. DOI: 10.1097/01.prs.0000260731.01178.18. 2. Sargent, L. A., & Rogers, G. F. (1999). Nasoethmoid orbital fractures: diagnosis and management. Journal of Craniomaxillofacial Trauma, 5(1), 19-27. 3. Wei, J. J., Tang, Z. L., Liu, L., Liao, X. J., Yu, Y. B., & Jing, W. (2015). The management of naso-orbital-ethmoid (NOE) fractures. Chinese Journal of Traumatology, 18(5), 296-301. DOI: 10.1016/j.cjtee.2015.07.006. 4. ChatGPT. 2023.