0:00

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

0:05

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

0:09

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

0:13

In this particular case, as you can see,

0:15

we have 0.5 mm thick axial raw data

0:19

which I'm scrolling through right here.

0:21

And they've already made 2 mm

0:23

thick coronal reconstructions.

0:25

On this example of a patient who has multiple fractures that

0:29

we've been using for both nasal bones

0:32

as well as orbital fractures,

0:33

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

0:36

into this fracture fragment at the very

0:39

top where there is comminution.

0:42

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

0:48

bone, and which also involves the

0:51

medial portion of the orbit here.

0:53

If we look at it on the right side and follow

0:56

the nasolacrimal duct here,

1:00

we see that there is fracture across that nasolacrimal

1:05

duct down low. And on the left side,

1:10

it looks as if this nasolacrimal duct is intact.

1:14

So let's look at the coronal reconstructions.

1:16

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

1:19

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

1:22

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

1:29

And in this situation,

1:31

as we scroll anteriorly to come forward,

1:34

you can better see the extent of the fractures going right

1:38

across those sutures that were previously described,

1:43

the frontonasal suture and the frontomaxillary suture.

1:47

And so this is this fragment here of the naso-

1:52

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

1:56

Here's the medial orbital wall fracture.

1:58

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

2:05

And on the right side

2:06

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

2:09

of the bony fragment into the nasolacrimal apparatus.

2:13

So this central portion fracture here is what is referred

2:17

to as the naso-orbito-ethmoidal fracture.

2:21

In this case comminuted, so type II.

Case 5 - NOE Fracture

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