The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patient-specific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. This review focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field.Due to the naso-orbital-ethmoid (NOE) complex's intricate anatomy, the fracture in this region has been one of the most challenging to manage in maxillofacial trauma. The NOE complex is a 3-dimensional delicate anatomic structure. Damage to any structure in this region, even minimal, is quite likely to result in the facial function and appearance abnormal.
M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTFurthermore, this complex structure has a compact relationship with the brain and eyes, because it separates the nasal, orbital cavities from cranial cavity. Therefore, as long as the fracture of the region is suspected, a thorough physical examination and radiographic assessment, such as 2-dimensional (2D) CT and 3-dimensional (3D) CT, must be performed to assess the type and extent of fracture after achieving the stable vital signs.At present, different types of approaches for exposure have been discussed, such as midfacial degloving and endoscopic approach, as well as management of the NOE fracture, such as bone tissue engineering. However, every procedure has its advantages and disadvantages. According to individual injures, the surgeon should select the patient-specific treatment to restore the normal facial function and appearance. This review will discuss the advancement in the field of NOE fracture management. NOE anatomy Bony structure: the NOE complex consists of the nasal bones, frontal process of the maxilla, nasal process of the frontal bone, lacrimal bone, lamina papyracea, ethmoid bone, sphenoid bone and nasal septum, which separate the nasal, orbital cavities from cranial cavity. 1,2 The medial orbital wall is made up of the lacrimal bone and the lamina papyracea of the ethmoid where blowout fracture is easy to occur (Figure 1). 1 Medial canthal tendon (MCT): MCT is the pivotal soft tissue in NOE area, which supports the canthus, enables proper apposition between the eyelid and the globe, and performs as the lacrimal pump. 2 However, there are many controversies on the anatomy of MCT. The main controversy is on the number of the tendon's limbs. Some scholars referred that it had three limbs: anterior, superior, posterior, 2 some others argued that the superior limb did not exist. 3 Furthermore, some report...