Resident Manual of Trauma to the Face, Head and Neck

CHAPTER 3: Upper Facial Trauma

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.

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Resident Manual of Trauma to the Face, Head, and Neck