In type III fractures, there is often comminution of the NOE area (as in type II fractures) and a detachment of the medial canthal tendon from the bone.
Involvement of the nasal bone
The nasal bones are usually involved and might not provide adequate dorsal support to the nasal bridge. In such cases bone graft reconstruction often is indicated.
Bilateral type III fracture with nasal bone involvement
The illustration shows a bilateral NOE type III fracture. The nasal bones are usually involved. Bone graft of the nasal dorsum is usually 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.