A patient sustains nasal trauma and presents with bilateral bluish subconjunctival hemorrhage, periorbital ecchymosis (raccoon eyes) and CSF rhinorrhea. The most likely associated fracture pattern is:

• A Le Fort I fracture
• B Isolated nasal bone fracture
• C Zygomatic complex fracture
• D Naso-orbito-ethmoid (NOE) fracture with skull base involvement ✓

Explanation

Raccoon eyes (bilateral periorbital ecchymosis from blood tracking along fascial planes) combined with CSF rhinorrhea indicate a skull base fracture involving the anterior cranial fossa. NOE fractures frequently extend to the cribriform plate causing dural tears and CSF rhinorrhea. Le Fort I is a low-level transverse maxillary fracture without skull base involvement. Isolated nasal fractures do not cause CSF rhinorrhea or bilateral periorbital ecchymosis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.