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Case 5 - NOE Fracture

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As I mentioned, with naso-orbito-ethmoidal fractures,

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NOE fractures, it's very useful to have multiplanar imaging.

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Again, I recommend that you start with the thin-section images.

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In this particular case, as you can see,

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we have 0.5 mm thick axial raw data

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which I'm scrolling through right here.

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And they've already made 2 mm

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thick coronal reconstructions.

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On this example of a patient who has multiple fractures that

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we've been using for both nasal bones

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as well as orbital fractures,

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we can see, as we go further and further superiorly, that we come

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into this fracture fragment at the very

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top where there is comminution.

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So a type II fracture, which is involving that central nasal

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bone, and which also involves the

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medial portion of the orbit here.

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If we look at it on the right side and follow

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the nasolacrimal duct here,

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we see that there is fracture across that nasolacrimal

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duct down low. And on the left side,

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it looks as if this nasolacrimal duct is intact.

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So let's look at the coronal reconstructions.

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Here we have the 2mm I've brought down. Here,

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we're going to make our own coronal reconstruction from the

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0.5 mm. So a little bit more noisy, but higher resolution.

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And in this situation,

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as we scroll anteriorly to come forward,

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you can better see the extent of the fractures going right

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across those sutures that were previously described,

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the frontonasal suture and the frontomaxillary suture.

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And so this is this fragment here of the naso-

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orbito-ethmoidal fracture, where it's kind of discontinuous.

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Here's the medial orbital wall fracture.

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And this is the nasolacrimal duct on the normal left side,

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And on the right side

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here, you can get a better sense of that degree of displacement

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of the bony fragment into the nasolacrimal apparatus.

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So this central portion fracture here is what is referred

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to as the naso-orbito-ethmoidal fracture.

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In this case comminuted, so type II.

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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