Abstract
Naso-orbito-ethmoid (NOE) fractures associated with anterior and posterior frontal sinus wall fractures are among the most challenging cranio-maxillofacial injuries. These represent a major emergency, having a potentially severe clinical picture, with intracranial hemorrhage, cerebrospinal fluid (CSF) leak, meningeal lesions, pneumocephalus, contusion or laceration of the brain matter, coma, and in some cases death. In this article, we present the case of a 30-year-old patient with the diagnosis of NOE fracture associated with bilateral anterior and posterior frontal sinus wall fractures caused by a horse kick, with a fulminant post-traumatic alteration of the neurological status and major impairment of the midface bone architecture. Despite the severity and complexity of the case, early initiation of correct treatment both in terms of intensive care and cranio-maxillofacial surgery led to the successful rehabilitation of the neurological status, as well as to the reconstruction and redimensioning of midface architecture and, not least, to the restoration of the patient’s physiognomy.
Highlights
A person’s physiognomy is directly dependent on the bone architecture and overlying soft tissues of the midface [1]
A key anatomical element that is affected in the case of NOE fractures is the medial canthal tendon (MCT), which inserts by two fascicles: an anterior fascicle in the anterior lacrimal crest of the maxillary frontal process and a posterior fascicle in the posterior lacrimal crest of the lacrimal bone, with the lacrimal sac between the two crests [3]
Naso-orbito-ethmoid (NOE) fracture associated with bilateral anterior and posterior frontal sinus wall fractures caused by a horse kick
Summary
A person’s physiognomy is directly dependent on the bone architecture and overlying soft tissues of the midface [1]. Naso-orbito-ethmoid (NOE) fractures alter the shape and projection of the nose, orbital contour, palpebral contour, and implicitly the eye shape, inducing severe functional and cosmetic disorders that practically disfigure the patient [2]. A key anatomical element that is affected in the case of NOE fractures is the medial canthal tendon (MCT), which inserts by two fascicles: an anterior fascicle in the anterior lacrimal crest of the maxillary frontal process and a posterior fascicle in the posterior lacrimal crest of the lacrimal bone, with the lacrimal sac between the two crests [3]. MCT represents the medial insertion of the eyelids, but it plays a role in lacrimal sac drainage [4]. The alteration of the MCT insertion has severe physiognomic consequences, clinically manifesting by rounded palpebral fissures and telecanthus [5]. Markowitz and Manson [6]
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