Reconstruction of Multifocal Comminuted Facial Fractures Caused by a Horse Kick

Introduction
Naso-orbital-ethmoidal (NOE) fractures are uncommon, complex facial fractures that
are often sustained following higher energy injury mechanisms. Common
mechanisms include road traffic accidents, sports injuries and horse kicks.
Anatomically, the NOE complex lies close to key facial structures including the orbits
and the anterior cranial fossa so damage to this complex can result in damage to
nearby structures. This can result in serious complications such as changes to vision
and intercranial infections.

Case Report
This case presents a 19-year-old patient who presented to the emergency
department following a horse kick to the face. Initial examinations revealed proptosis
and increased intercanthal distance. Imaging showed us that there were multifocal
comminuted fractures that involved the NOE complex, anterior cranial fossa, the
orbits, a retro-orbital haematoma, a small subdural haemorrhage and a small,
depressed skull fracture. The NOE fracture was determined to be a type 2 fracture
according to the Markowitz and Manson classification. Despite the severity of the
injuries, the patient remained GCS 15 throughout their care. For repair, an open
reduction and internal fixation using a coronal flap with cranialisation of the frontal
sinus was carried out.

Discussion
This case discusses the importance of early recognition and multidisciplinary
management of NOE fractures. Appropriate surgical intervention based on the
Markowitz and Manson classification is important in reducing complications such as
meningitis, facial deformities and ocular changes. Management of NOE fractures is
also important in order to achieve a good aesthetic outcome for the patient.