A naso-ethmoidal (naso-orbito-ethmoid, NOE) fracture is a complex break of the bones between the eyes where the nose, eye sockets and skull base meet, usually from a strong blow to the central face. Early surgical repair helps prevent widened eye corners (telecanthus), nasal flattening, sunken eyes and other lasting problems.
- AnaesthesiaGeneral
- DurationTypically 2 to 4 hours
- Hospital stayUsually 2 to 4 days
What is naso-ethmoidal fractures?
Nasal bone fractures are among the most common facial fractures and need proper management to avoid later functional and cosmetic problems. Naso-ethmoidal fractures are more complex: they usually result from a strong blow to the centre of the midface, most often in road traffic accidents and then assaults, with force passing back through the ethmoid bone.
The naso-orbito-ethmoid (NOE) region joins the nose, sinuses, eye sockets and skull base. Poorly repaired injuries here cause deformities that are very difficult to correct later. Untreated or inadequately treated NOE fractures can lead to vision problems, telecanthus (widened distance between the inner eye corners), sunken eyes, midface flattening, CSF leak, loss of smell, watering eyes, sinusitis and nasal deformity.
NOE fractures are classified into three types: Type I, a single large central fragment without disruption of the medial canthal tendon; Type II, a comminuted central fragment with the tendon still attached; and Type III, severe comminution with the medial canthal tendon disrupted. Surgery aims to protect the eye and brain, prevent early and late complications and restore facial contour.
Who is naso-ethmoidal fractures for?
- Nasal deformity after a fracture
- Swelling and lacerations of the nose and forehead
- Double vision (diplopia)
- Telecanthus (widened inner eye corners)
- CSF rhinorrhoea (clear fluid leaking from the nose), managed with neurosurgical input
How is it done?
- Detailed CT assessment; surgery is deferred until life-threatening injuries, severe head injury and eye or optic nerve injuries are stabilised
- Coronal (scalp) incision gives the best access to the sinuses, frontal bone, nasal bones and orbital rims
- Lower eyelid (subciliary) incision for the lower orbital rim and floor
- Existing lacerations may be used for access
- Fragments are reduced and fixed with small plates, and the medial canthal tendon is reattached if disrupted
What is recovery like?
- Drink fluids and eat soft foods; avoid hot food and drinks initially
- Avoid pressure on the nose and avoid bending the head below heart level
- Keep the mouth clean and sneeze with the mouth open
- Apply ice to the nasal area to reduce swelling
- Avoid smoking and alcohol for at least ten days
What are the risks?
- Minor bleeding, haematoma and infection
- Nerve injury, bruising and swelling
- Altered sense of smell or breathing
- Infection of any bone graft
- Worsening of a CSF leak; persistent telecanthus or nasal deformity
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
What is the difference between a broken nose and a naso-ethmoidal fracture?
A simple nasal fracture involves only the nasal bones. A naso-ethmoidal fracture extends deeper into the bones between the eyes, the inner walls of the eye sockets and sometimes the skull base. It is more complex, can affect the eyes, tear drainage and brain coverings, and usually needs open surgical repair.
What is telecanthus?
Telecanthus is an abnormal widening of the distance between the inner corners of the eyes. In NOE fractures, it happens when the bone holding the medial canthal tendon is displaced or the tendon is torn. It is much easier to correct at the initial repair than later.
When might surgery be delayed?
Surgery may be postponed when there are other life-threatening injuries or a severe head injury, when eye or optic nerve injuries need to be stabilised first, or when bleeding tendency, diabetes or blood pressure are not controlled. The team aims to repair the fracture as soon as it is safe.
How should I care for my face after NOE fracture surgery?
Eat soft foods, avoid hot drinks at first, keep the mouth clean, apply ice to reduce swelling, avoid pressure on the nose, sneeze with your mouth open and avoid blowing your nose. Do not smoke or drink alcohol for at least ten days and keep all follow-up visits.
