Naso-ethmoid fracture - Revision history

Danbot: Expand: bowstring test, avoid nasal tubes, CT evaluation

2026-03-21T01:42:35Z

Expand: bowstring test, avoid nasal tubes, CT evaluation

← Revisión anterior		Revisión del 01:42 21 mar 2026
Línea 1:		Línea 1:
	==Background==		==Background==
			*Also known as naso-orbito-ethmoid (NOE) fracture
			*Results from high-energy direct impact to nasal bridge
			*Involves the nasal bones, ethmoid sinuses, medial orbital walls, and frontal process of maxilla
			*Medial canthal ligament (MCL) disruption is the key complication
			*Associated intracranial injury in up to 70% of cases

	==~~Evaluation~~==		==Clinical Features==
	*~~Diffuse tearing and~~ increased intercanthal distance ~~are suggestive~~		*Flattened nasal bridge, telecanthus (increased intercanthal distance >35mm)
	*~~Intranasal palpation with hemostat while palpating along bony rim for crepitus~~		*Periorbital ecchymosis, edema
			*[[Epistaxis]]
			*Epiphora (tearing) from lacrimal apparatus disruption
			*CSF rhinorrhea if cribriform plate/dura involved
			*'''Bowstring test:''' Pull lateral canthus laterally; if medial canthus moves freely, MCL is disrupted

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Maxillofacial trauma DDX}}		{{Maxillofacial trauma DDX}}

			==Evaluation==
			*CT face with thin cuts through orbits and ethmoid — gold standard
			*Bimanual palpation: hemostat intranasally while palpating medial orbital rim externally for crepitus
			*Evaluate for CSF leak (halo test, beta-2 transferrin)
			*Ophthalmology assessment for globe injury

	==Management==		==Management==
			*'''Avoid nasotracheal intubation and NG tubes''' if cribriform plate disrupted
			*Control [[epistaxis]] with anterior packing
			*Antibiotics if open fracture or CSF leak
			*Definitive repair by ENT/facial surgery (often delayed 5-7 days for edema)

	==~~Prognosis~~==		==Disposition==
	*~~Complications include:~~		*Admit for associated injuries (intracranial, orbital)
	**Lacrimal disruption		*ENT/maxillofacial surgery and neurosurgery consults as indicated
	**Medial canthal ligament rupture
	**Dural tears
	**Intracranial injury seen in up to 70%

	==See Also==		==See Also==
			*[[Nasal fracture]]
	*[[Orbital fracture]]		*[[Orbital fracture]]
			*[[Le Fort fractures]]
			*[[Basilar skull fracture]]

	==References==		==References==
	<references/>		<references/>


	[[Category:ENT]]		[[Category:ENT]]
	[[Category:Orthopedics]]		[[Category:Orthopedics]]
	[[Category:Trauma]]		[[Category:Trauma]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T22:35:22Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 22:35 23 jul 2016
Línea 1:		Línea 1:
	==Background==		==Background==

	==~~Diagnosis~~==		==Evaluation==
	*Diffuse tearing and increased intercanthal distance are suggestive		*Diffuse tearing and increased intercanthal distance are suggestive
	*Intranasal palpation with hemostat while palpating along bony rim for crepitus		*Intranasal palpation with hemostat while palpating along bony rim for crepitus

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-12T18:08:47Z

Text replacement - " w/ " to " with "

← Revisión anterior		Revisión del 18:08 12 jul 2016
Línea 3:		Línea 3:
	==Diagnosis==		==Diagnosis==
	*Diffuse tearing and increased intercanthal distance are suggestive		*Diffuse tearing and increased intercanthal distance are suggestive
	*Intranasal palpation w/ hemostat while palpating along bony rim for crepitus		*Intranasal palpation with hemostat while palpating along bony rim for crepitus

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "==Source==" to "==References== "

2016-06-26T06:03:48Z

Text replacement - "==Source==" to "==References== <references/>"

← Revisión anterior		Revisión del 06:03 26 jun 2016
Línea 20:		Línea 20:
	*[[Orbital fracture]]		*[[Orbital fracture]]

	==~~Source~~==		==References==
			<references/>

Neil.m.young: Text replacement - "*Tintinalli" to ""

2016-06-26T02:19:38Z

Text replacement - "*Tintinalli" to ""

← Revisión anterior		Revisión del 02:19 26 jun 2016
Línea 21:		Línea 21:

	==Source==		==Source==
	*Tintinalli

	[[Category:ENT]]		[[Category:ENT]]
	[[Category:Orthopedics]]		[[Category:Orthopedics]]
	[[Category:Trauma]]		[[Category:Trauma]]

Ostermayer: Text replacement - "Category:Ortho" to "Category:Orthopedics"

2016-03-22T15:48:40Z

Text replacement - "Category:Ortho" to "Category:Orthopedics"

← Revisión anterior		Revisión del 15:48 22 mar 2016
Línea 24:		Línea 24:

	[[Category:ENT]]		[[Category:ENT]]
	[[Category:~~Ortho~~]]		[[Category:Orthopedics]]
	[[Category:Trauma]]		[[Category:Trauma]]

Rossdonaldson1: /* See Also */

2015-11-08T14:56:56Z

Rossdonaldson1: /* See Also */

2015-11-08T14:56:49Z

Rossdonaldson1: /* Prognosis */

2015-11-08T14:56:31Z

Prognosis

← Revisión anterior		Revisión del 14:56 8 nov 2015
Línea 11:		Línea 11:

	==Prognosis==		==Prognosis==
	**Complications include:		*Complications include:
	***Lacrimal disruption		**Lacrimal disruption
	***Medial canthal ligament rupture		**Medial canthal ligament rupture
	***Dural tears		**Dural tears
	***Intracranial injury seen in up to 70%		**Intracranial injury seen in up to 70%

	==See Also==		==See Also==

Rossdonaldson1: Rossdonaldson1 moved page Naso-Ethmoid Fracture to Naso-ethmoid fracture

2015-01-10T08:30:48Z

Rossdonaldson1 moved page Naso-Ethmoid Fracture to Naso-ethmoid fracture

← Revisión anterior	Revisión del 08:30 10 ene 2015
(Sin diferencias)

← Revisión anterior		Revisión del 14:56 8 nov 2015
Línea 18:		Línea 18:

	==See Also==		==See Also==
	*[Orbital fracture]]		*[[Orbital fracture]]

	==Source==		==Source==