Fronto-Naso-Orbito-Ethmoidal Fractures

Maxillofacial fractures often result from blunt trauma such as vehicular accidents, assaults, sports injuries, and falls, with penetrating injuries being less common. Among these, naso-orbito-ethmoidal (NOE) fractures are particularly complex due to their involvement of the frontal, nasal, lacrimal, maxillary, and ethmoid bones. These fractures compromise the medial canthal tendon (MCT), leading to functional and aesthetic deformities such as telecanthus, enophthalmos, nasal deformity, and CSF leaks. Markowitz and Manson classified NOE fractures into three types, depending on MCT involvement. Diagnosis is challenging due to edema and soft tissue injury; hence, thin-cut CT with 3D reconstruction remains the gold standard. Clinical signs include swelling, diplopia, CSF rhinorrhea, and altered intercanthal distance. The primary surgical goals are restoring MCT insertion, protecting orbital and intracranial contents, and reconstructing facial symmetry. Most displaced fractures require open reduction and internal fixation, often via coronal approach, with careful reduction from stable cranial to central facial structures.