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Case 5 - Midface NOE Fracture

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Let's look at another NOE fracture. So, N for nasal bones,

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and we see that they are fractured. And Nalso for the

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nasofrontal or nasal maxillary sutures that may

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be involved. O for the orbital involvement.

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Here we see the medial orbital wall fracture with a fragment

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along that medial canthal ligament, which is seen right

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along here, and that's involved on the left side.

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The O may also involve the nasolacrimal duct. In this case,

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although the reconstructions are not that great,

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it does look like that duct is intact.

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The E is the ethmoidal, and that's usually the superior

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fragment here that goes across the top of the ethmoid sinus.

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And you can see a comminuted fracture here that is involving

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both the frontal sinus, as well as the anterior ethmoid sinus

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and therefore may be potentially involved at the frontal

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ethmoidal recess or nasofrontal duct.

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Notice that this, again, looks like it's comminuted

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and displaced inward this central fragment.

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When we look at it on the coronal reconstruction, you can

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see the plane of the fracture across the top of the ethmoid

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bone. Here's the perpendicular plate of the ethmoid bone.

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And this is going from right to left involving the medial

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orbital wall, which is typical of NOE fractures.

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When we look at the lacrimal duct here and the lacrimal

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duct here, not too bad.

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Those look like they are intact.

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But this big segment here is a large fracture fragment

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that shows some element of comminution.

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Let's take a quick look at the 3D reconstruction, and you can

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see the plane of the fracture here

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and the orbital floor fractures.

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This is like a little mid-face buttress

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large fracture fragment that may be floating and requires

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usually immediate surgical intervention.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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