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CHAPTER 3: Upper Facial Trauma
Resident Manual of Trauma to the Face, Head, and Neck
52
A. Anatomic Structures of the NOE Complex
NOE fractures can involve damage to multiple important osseous,
vascular, cranial nerve, and supporting structures located within the
NOE complex, including:
y
y
Nasal bones (Figure 3.11).
y
y
Perpendicular plate of the ethmoid/septum.
y
y
Nasal process of the frontal bone.
y
y
Cribriform plate and olfactory nerve.
y
y
Lamina papyracea, medial orbit, ethmoid sinus.
y
y
Orbital fat, medial rectus muscle, superior oblique muscle with
trochlea.
y
y
Ethmoid arteries, ethmoid nerves.
y
y
Medial canthal attachments (Figure 3.12).
y
y
Lacrimal fossa, lacrimal sac, superior and inferior canaliculi, superior
portion of the nasal-lacrimal duct (Figure 3.13).
y
y
Nasal process of the maxilla and lateral-superior nasal wall.
Figure 3.11
NOE pertinent osteology—(1) nasal process
of frontal bone; (2) nasal bones; (3) nasal
process of maxilla; (4) lacrimal bone; (5)
lamina papyracea; (6) lesser wing of
sphenoid bone.
Figure 3.12
Anterior and posterior slips of the
medial canthal tendon surrounding
the lacrimal sac—(1) pretarsal
orbicularis muscle; (2) preseptal
orbicularis muscle; (3) preorbital
orbicularis muscle.
Figure 3.13
Nasal lacrimal system anatomy—(A) lacrimal gland;
(B) superior and inferior canaliculi; (C) lacrimal sac;
(D) nasolacrimal duct; (E) reflected anterior slip of
medial canthal tendon.