In unilateral type II fractures, there is often comminution of the NOE area, but the canthal tendon remains attached to a fragment of bone, allowing the canthus to be stabilized with wires or a small plate on the fractured segment.
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.
Bilateral type II fracture with nasal bone involvement
The illustration shows a bilateral NOE type II fracture. In bilateral fractures the nasal bones are commonly involved. In some instances, bone grafting of the nasal dorsum may be necessary.
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.