Naso-ethmoid fracture: Difference between revisions
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(Expand: bowstring test, avoid nasal tubes, CT evaluation) |
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** | ==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 DDX}} | |||
==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 | |||
==See Also== | ==See Also== | ||
[[ | *[[Nasal fracture]] | ||
*[[Orbital fracture]] | |||
*[[Le Fort fractures]] | |||
*[[Basilar skull fracture]] | |||
==References== | |||
<references/> | |||
[[Category:ENT]] | |||
[[Category:Orthopedics]] | |||
[[Category:Trauma]] | |||
Latest revision as of 01:42, 21 March 2026
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