Resident Manual of Trauma to the Face, Head and Neck

B. Indications of Injury to the NOE Complex Structures In general, the subjective symptoms and objective signs of injuries to the NOE complex will reflect the pathology evidenced by the specific structures that are injured. 1. Symptoms (Subjective) The subjective symptoms of injuries to the NOE complex include the following: y y Diplopia. y y Nasal stuffiness. y y Epistaxis. y y Visual disturbances. y y Pain. y y Dizziness, vertigo. y y Anosmia. 2. Signs (Objective) a. Traumatic Telecanthus The average interpupillary distance is 60–62 millimeters (mm), which corresponds to an intercanthal distance of approximately 30–31 mm. The diagnosis of traumatic telecanthus requires a measurement in excess of those normative values (Figures 3.14 and 3.15). The pathology can be either unilateral or bilateral, with the former more difficult to measure.

Figure 3.15 Patient demonstrating traumatic telecanthus with splaying of the NOE complex.

Figure 3.14 Normal interpupillary and intercanthal distances, and traumatic telecanthus widening.

53

www.entnet.org