Surgical management of naso-orbito-ethmoidal fractures: a systematic review

ObjectiveNaso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors and post-operative outcomes associated with the surgical management of NOE fractures.Study DesignPubMed and Scopus databases were systematically searched between 1993 and 2023 using the search strategy "(naso-orbito-ethmoidal OR nasoethmoid OR nasoorbitoethmoidal) AND fracture". Inclusion criteria were: clinical studies investigating the surgical management of NOE fractures. Exclusion criteria were: duplicates; non-English; non-full-texts; unclear age range; insufficient data; sample size less than ten. Data on patient factors, procedural factors and post-operative outcomes were extracted.ResultsOf the 412 articles identified, 6 eligible articles (retrospective case series) representing 95 adult cases and 84 paediatric cases were included. Mean ages were 29.0 and 10.2 years respectively. Most cases were male (65.3%; 73.9%). Motor vehicle accidents were the most common mechanism (79.2%; 50.0%). Coronal incision was the most common approach. Epiphora (n=33) and scar problems (n=21) were the most common complications in adult and paediatric cases respectively.ConclusionsFurther robust longitudinal studies with clear description of fracture classification and operation timing would be helpful. Gaps in knowledge include concomitant injuries, digitally-assisted applications and risk factors for adverse outcomes.