Traumatologie im Bereich des NOE-Komplexes

Fractures of the central midface and those of the naso-orbito-ethmoidal (NOE) complex region often occur in combination with other fractures of the facial skeleton. Due to the thin bone structure in this part of the face, facture osteosynthesis is challenging, especially in the presence of comminution. The fractures are classified as type I–III according to Markowitz. Type I is a non- or low dislocated, non-comminuted fracture of the NOE complex without avulsion of the medial canthal ligament. Type II is a comminuted fracture of the NOE complex, whereby the medial canthal ligament is still fixed to a larger bony fragment and reduction can be achieved by reposition of the bony fragments. In a type III fracture according to Markowitz, there is both pronounced comminution and bony avulsion of the medial eyelid ligament. Clinically, type II and especially type III fractures are characterized by a telecanthus and a flattened nasal bridge. Primary treatment of such fractures is demanding but must be carried out with appropriate care, as secondary correction of a posttraumatic deformity in this area is much more difficult. If the medial canthal ligament is torn, it must be refixed via medial canthopexy in addition to bony reduction and osteosynthesis. Transnasal wire canthopexy has proven successful for this purpose. It is typically performed via a coronal approach, but also a minimally invasive approach via a glabellar incision is feasible. The treatment of complex midface fractures, such as fractures of the NOE complex, should be carried out in specialized trauma centers.