In unilateral Markowitz type I fractures, there is a single large NOE fragment bearing the medial canthal tendon.
Involvement of the nasal bone
The nasal bone may also be involved and, in cases of comminution, may not provide adequate dorsal support to the nasal bridge.
The nasoorbitoethmoidal (NOE) fracture refers to injuries involving the area of confluence of the nose, orbit, ethmoids, the base of the frontal sinus, and the floor of the anterior cranial base. The area includes the insertion of the medial canthal tendon(s). NOE fractures, by definition, are a different entity than isolated nasal bone fractures. However, they are often associated with fractures of the nasal bones.
NOE fractures are most commonly classified according to Markowitz BL, Manson PN, Sargent L, et al (1991) Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment. Plast Reconstr Surg. 87(5):843-53:
These can be unilateral or bilateral injuries.
Involvement of buttresses
NOE complex fractures involve the medial vertical (nasomaxillary) buttresses of the facial skeleton. Click here for further details on buttresses.
Association with frontal sinus fractures
NOE fractures are often associated with frontal sinus fractures.