Naso-orbital-ethmoidal (NOE) fractures: Surgical Anatomy, Management and Controversies

Abstract

Naso-orbital-ethmoidal (NOE) fractures are among the most complex maxillofacial injuries, involving disruption of the nasal, lacrimal and medial orbital structures. They often result in telecanthus, nasal flattening and functional deformities. Accurate diagnosis relies on clinical assessment, the bimanual nasoethmoidal test and computed tomography. Management has evolved from closed reduction to open reduction with rigid fixation based on the Markowitz classification. Early surgical intervention within two weeks yields optimal results. The coronal approach provides excellent exposure, while autogenous bone grafting—preferably calvarial—is essential in comminuted fractures. Despite advances in fixation and grafting, controversies persist regarding surgical timing, approach selection and management of the canthal and lacrimal systems. Successful outcomes depend on precise anatomical restoration and multidisciplinary care.