Nasal and Nasoethmoidal-Orbital Fractures: A Continuum of Injury

Abstract

The unilateral nasoethmoid orbital (NOE) fracture is frequently misdiagnosed. This fracture is independent of the clinically obvious NOE fracture and has alternately been referred to as complex nasal, minimally displaced, occult or greenstick NOE fracture. Failure to identify and treat these injuries at initial presentation results in undesirable aesthetic and functional consequences that are difficult to repair secondarily. Three patients who presented with nasal fractures complicated by minimally displaced fractures of the medial orbital wall were reviewed retrospectively. These injuries were successfully diagnosed and treated after their examining physicians failed to appreciate the injury on the initial evaluation. Complex nasal injuries with fracture extensions to the NOE are often missed by the examining physician. These injuries should benefit from a high index of suspicion and be evaluated with axial and coronal computed tomographic imaging. Acute treatment with appropriate exposure, open reduction, internal fixation and bone grafting is most compatible with a successful outcome.