A patient involved in a road traffic accident presents with a telecanthus, flattened nasal bridge, CSF rhinorrhea, and marked periorbital edema. CT facial bones show comminuted fractures of the naso-ethmoid-orbital (NOE) complex. Based on the Markowitz-Manson classification, a Type III NOE fracture is distinguished by:

• A Single large central fragment with intact medial canthal tendon attachment
• B Comminuted central fragment with medial canthal tendon avulsed from all bony attachments ✓
• C Comminuted central fragment with medial canthal tendon attached to bone fragment
• D Bilateral NOE fracture with bilateral medial canthal tendon avulsion

Explanation

The Markowitz-Manson NOE classification is based on the status of the medial canthal tendon (MCT) attachment: Type I — single central fragment, MCT intact on the fragment; Type II — comminuted central fragment, MCT remains attached to a bony fragment; Type III — comminuted central fragment with MCT avulsed from all bony fragments (complete ligamentous detachment). Type III is the most severe, requiring transnasal wiring for MCT reattachment in addition to bony reconstruction. This classification directly guides surgical management.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.