Craniofacial & Facial Reconstruction
Naso-orbito-ethmoid fracture reconstruction repairs broken bones around the nasal bridge and inner eye sockets to restore facial support, alignment, and function.
Is this the same as fixing a broken nose?
No. It involves a deeper and more complex part of the central face.
The injury may include the inner eye sockets, ethmoid bones between the eyes, and the attachment that holds each inner eyelid corner in position.
Will every fracture need surgery?
Not necessarily; treatment depends on displacement and stability.
A surgeon reviews examination findings and CT images to assess bone alignment, eyelid support, eye function, and associated injuries.
When is reconstruction done?
Timing depends on the injury and your overall condition.
Vision-threatening injuries need urgent care. Definitive reconstruction may follow stabilization and assessment of swelling, but some repairs are time-sensitive.
01 · Overview
Naso-orbito-ethmoid, or NOE, fractures involve the central facial framework where the nose meets the inner eye sockets. Facial trauma can also injure nearby soft tissues, teeth, nerves, and eyes, so assessment looks beyond the visible shape of the nose. [1]
An important structure in this area is the medial canthal tendon, which anchors the inner corner of each eyelid. When its bony attachment breaks or the tendon separates, the inner eye corners may spread apart. Reconstruction may need to restore both the bones and this attachment.
This operation is different from cosmetic rhinoplasty and from treatment of an isolated broken nose. Depending on the injury, a craniofacial or facial trauma surgeon may coordinate with eye, ear-nose-throat, or neurosurgical specialists. The plan is based on CT imaging, examination, and your medical stability.
The size and stability of the bone holding the inner eyelid tendon help determine the repair. A large stable fragment may be repositioned and fixed. A fragmented attachment or detached tendon may require separate anchoring to restore inner eyelid support.
Your team assesses vision, eye movement, tear drainage, nasal breathing, and nearby facial fractures. Severe central facial injuries can also involve the skull base or a leak of cerebrospinal fluid, the fluid around the brain.
02 · Concerns & Goals
A naso-orbito-ethmoid injury can affect both appearance and important structures around the eyes and nose. Your team will first assess urgent concerns, then discuss reconstruction.
Displaced bones can reduce nasal projection or widen the center of the face. Repair aims to rebuild support rather than simply reshape the outside of the nose.
Damage to the tendon attachment can increase the distance between the inner eyelid corners or change eyelid position.
Swelling and structural damage may obstruct nasal airflow. Injury near the tear ducts may cause persistent tearing.
Double vision, altered eye position, or numbness may accompany the fracture. New or worsening vision changes require urgent assessment.
03 · Options
These approaches may be combined. Your surgeon recommends a plan based on fracture displacement, bone fragmentation, tendon support, and associated injuries.
Selected stable, minimally displaced injuries may not need reconstruction.
Displaced bone fragments are returned toward their normal position and secured.
The inner eyelid attachment is restored when bone fixation alone is not enough.
Missing support or a healed deformity may require a more extensive rebuild.
General facial trauma care may involve observation or surgery. NOE fractures require a specialist plan because the inner eyelid attachments and nearby eye structures may also be injured. [1].
Access may involve existing injury wounds or incisions near the eyelids, inside the mouth, or within the scalp. Not everyone needs all of these approaches. Ask your surgeon where your incisions will be and what scars or sensation changes may follow.
Sometimes, but not always. Early tearing may reflect swelling rather than permanent blockage. Your team may involve an eye specialist and reassess drainage after the initial repair before recommending another procedure.
04 · Results
Reconstruction aims to restore the framework of the central face.
Breathing, eyelid support, and eye protection are important goals.
The final contour takes time to assess.
Facial trauma outcomes depend on the location and severity of the injury, including damage to surrounding tissues. Reconstruction cannot guarantee a return to the exact preinjury appearance or function. [1]
05 · Recovery
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery varies with the extent of the fracture, associated injuries, and surgical approach. Your team's instructions take priority; returning to work does not mean the bones or soft tissues are fully healed.
Step 1 · Surgery and immediate monitoring
The team monitors breathing, vision, bleeding, and pain. Hospital observation may be needed, especially with multiple injuries. Dressings, splints, or other supports depend on the repair.
Step 2 · First days to two weeks
Swelling, bruising, congestion, and discomfort are common. Follow-up may include wound checks and assessment of vision and eyelid position. Ask your surgical team whether compresses are appropriate and exactly how to use them.
Step 3 · Following weeks
Activity restrictions are adjusted as healing progresses. Your surgeon decides when the repair can tolerate lifting, exercise, nasal pressure, and possible impact.
Step 4 · Following months
The team reassesses facial contour, eye-corner position, breathing, tearing, and sensation. Persistent concerns may lead to further testing or discussion of staged treatment.
Request a written activity plan specific to your repair, including how to protect the nasal bridge from glasses or other pressure.
They are often left in place if they are not causing problems. Infection, exposure, discomfort, or other circumstances may prompt removal. Children may need additional planning around facial growth.
Swelling and nerve irritation may improve over time, but some symptoms persist. Follow-up examinations help distinguish healing-related symptoms from tear-duct blockage or lasting nerve injury. Report worsening symptoms rather than waiting for the next routine visit.
06 · Safety
Swelling, bruising, nasal stuffiness, tenderness, and temporary altered sensation can occur after repair. Their degree and duration vary. New vision changes, rapidly increasing swelling, or worsening pain should not be assumed to be routine healing.
Surgery can cause bleeding, wound infection, or reactions to anesthesia. Your health and other injuries affect these risks.
Double vision or altered eye position may persist or develop. Rarely, injury or surgical complications can threaten sight.
Inner eye-corner widening, eyelid position changes, flattening, or uneven contours may remain despite repair.
Tear-drainage damage and internal nasal changes may require later specialist treatment.
Sensation changes can last, scars may be noticeable, and plates or screws may become palpable, irritated, exposed, or infected.
Bone position can shift, grafts may not heal as intended, or additional reconstruction may be needed. Associated skull-base injuries require separate monitoring for fluid leakage or infection.
Discuss these risks and your individual health history with your surgeon. [1]
07 · Costs
Compare written estimates for the same planned scope, including fracture repair, tendon stabilization, grafting, and any coordinated specialist care. Trauma coverage, hospital billing, and later reconstruction may be handled differently by your insurance plan.
Surgeon
Surgeon services for assessment and the planned reconstruction.
Ask your surgeonAsk which repairs, specialist procedures, and postoperative visits are included, and how later revision would be billed.
Facility
Anesthesia services, operating-room care, and hospital or facility services.
Ask your surgeonAsk about separate professional bills, inpatient charges, and network participation.
Supplies
Potential charges for implants, graft materials, splints, medicines, imaging, and follow-up testing.
Ask your surgeonConfirm which items are included and whether eye or tear-drainage evaluations generate separate charges.
TRC
Any separately listed administrative or care-coordination services.
Ask TRCAsk whether these services apply, what they include, and whether they are optional or covered by insurance.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Yes, delayed reconstruction may be possible. Once bones have healed in a displaced position, repair may require releasing or recutting bone, grafting, or rebuilding tendon support. A consultation is needed to understand the limits and likely stages.
That cannot be guaranteed. The goal is to restore support, alignment, and function as closely as the injury allows. Preinjury photographs may help your surgeon understand your original anatomy.
Not automatically. NOE reconstruction treats trauma-related structural damage. Any later nasal reshaping or airway procedure should be discussed separately, including timing and insurance considerations.
A surgeon experienced in complex facial trauma should evaluate it. Depending on local services and the injury, this may be a craniofacial plastic surgeon, oral and maxillofacial surgeon, or facial trauma-trained ear-nose-throat surgeon, with eye or neurosurgical specialists involved when needed.
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