PURPOSE: Naso-orbital ethmoid (NOE) fractures are categorized according to the Markowitz-Manson classification system. Type I NOEs are the most common pattern but have varying clinical and radiographic characteristics. There is no literature to date that accounts for these differences. This study describes critical features of type I fractures and their effect on clinical symptoms and need for operative intervention.
METHODS: A retrospective review was conducted on patients with NOE fractures from 2011 to 2019. CT scans with three-dimensional reconstructions were used to characterize type I NOE fractures. The primary outcomes were symptoms necessitating surgery and whether operative intervention was performed.
RESULTS: In total, 106 NOE fractures were identified. Type I pattern was seen in 92% (97/106), type II in 8% (8/106), and type III in 1% (1/106). Type I fractures exhibited four patterns of displacement relative to the nasofrontal junction. They were designated as type 0 “nondisplaced” (52%), type IA “impacted and internally rotated” (34%), type IB “impacted and externally rotated” (13%), and type IC “blow-out” fractures (1%). Among type I fractures, displaced NOEs were 30 times more likely to need operative intervention versus nondisplaced (P < 0.001). Type IA was 1.3 times more likely to need operative intervention and had a greater risk of trouble breathing and internal nasal valve collapse compared to type 0 and type IB patterns (P < 0.05).
CONCLUSIONS: Degree and direction of displacement is critical when assessing type I NOE fractures. Both displacement and specifically impaction with internal rotation are significantly associated with patient morbidity and need for surgical treatment.