Diferencia entre revisiones de «Naso-ethmoid fracture»

Revisión actual - 01:42 21 mar 2026

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

Clinical Features

Flattened nasal bridge, telecanthus (increased intercanthal distance >35mm)
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

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

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

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)

Disposition

Admit for associated injuries (intracranial, orbital)
ENT/maxillofacial surgery and neurosurgery consults as indicated

References

Authors:

@@ Línea 1: / Línea 1: @@
 ==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
-==Diagnosis==
+==Clinical Features==
-**Diffuse tearing and increased intercanthal distance are suggestive
+*Flattened nasal bridge, telecanthus (increased intercanthal distance >35mm)
-**Intranasal palpation w/ 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
-==Prognosis==
+==Differential Diagnosis==
-**Complications include:
+{{Maxillofacial trauma DDX}}
-***Lacrimal disruption
-***Medial canthal ligament rupture
+==Evaluation==
-***Dural tears
+*CT face with thin cuts through orbits and ethmoid — gold standard
-***Intracranial injury seen in up to 70%
+*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==
+*'''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)
+==Disposition==
+*Admit for associated injuries (intracranial, orbital)
+*ENT/maxillofacial surgery and neurosurgery consults as indicated
 ==See Also==
-[[Maxillofacial Trauma]]
+*[[Nasal fracture]]
+*[[Orbital fracture]]
+*[[Le Fort fractures]]
+*[[Basilar skull fracture]]
-==Source==
+==References==
-Tintinalli
+<references/>
 [[Category:ENT]]
-[[Category:Ortho]]
+[[Category:Orthopedics]]
 [[Category:Trauma]]