Naso EthmoidalOrbital Injuries

Suspect NEO injuries in those with trauma to the bridge of the nose or medial orbital wall ( Fig 24915). The mechanism of injury is usually dramatic, and these fractures are not likely due to fisticuffs. NEO fractures are frequently associated with lacrimal disruption and dural tears. Patients may complain of pain on eye movement, and physical examination may reveal traumatic telecanthus or epiphora (tears spilling over the lid).

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FIG. 249-5. Schematic of midfacial fracture lines: Le Fort I, II, and III. (Reprinted with permission from Dingman RO, Natvig P: Surgery of Facial Fractures. Philadelphia, Saunders, 1964, p 248.)

If the medial canthus is tender, perform the intranasal palpation test and examine for CSF rhinorrhea. Plain radiographs are insensitive. 15 If the examination is suggestive, order a CT of the face to include coronal sections and thin axial slices through the medial orbital wall.

If an NEO fracture is present, consult a maxillofacial surgeon. As with many facial fractures, antibiotics are frequently prescribed for CSF leaks; however, no controlled studies have proven their efficacy. Some believe prophylactic antibiotics increase the risk of resistant organisms.

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