Anatomy of the noe complex.

Bony anatomy the NOE complex is vulnerable to injury because of its

prominent position at the junction of the upper and middle thirds of the face.
Like the midface, it is a ed!e"shaped structure oriented so that the narro
portion faces anteriorly and the broader base lies posteriorly beteen the to
orbits. #his arran!ement compensates for the inherent eakness created by
lar!e underlyin! sinus spaces $the ethmoidal sinuses%. Additional stren!th is
provided by the or!ani&ation of the complex into a lattice ith individual
bones oriented at different an!les to one another. #he NOE complex is
composed of our paired bones' the lateral nasal bones, the frontal processes
of the maxilla, the lamina papyraceae of the ethmoid bone, and the lacrimal
bones. #he perpendicular and cribirform plates of the ethmoid bone, the
nasal process of the frontal bone, and the sphenoid bone complete the bony
skeleton in the midline. #he area beteen the to medial orbital alls and
belo the anterior cranial fossa is sometimes referred to as the interorbital
space. (ithin the upper portion of the nasal cavity lie the superior and
middle turbinates, but these structures do not contribute to the structural
support of the complex.
)edial *anthal Anatomy. #he medial aspects of the upper and loer
eyelids conver!e into an acute an!le and form the medial canthus. +ere,
deep and superficial extensions of the preseptal and pretarsal orbicularis
oculi conver!e into a common tendon. #he tendon, hich functions as the
ori!in of the orbicularis oculi muscle, divides into anterior and posterior
bands before attachin! to the bone. #he anterior limb is the lar!er and more
si!nificant of the to. ,t inserts broadly into the frontal process of the
maxilla, the anterior lacrimal crest $part of the maxillary bone%, and the
lateralmost aspect of the nasal bone. ,f disrupted by injury, restoration of
this attachment is essential to the successful reconstruction of the NOE
complex. #he smaller posterior limb of the medial canthal tendon is poorly
defined and inserts into the posterior lacrimal crest, hich is part of the
lacrima l bone. ,t is composed of the deep head of the pretarsal orbicularis
oculi $horner-s muscle% and is !enerally i!nored durin! reconstruction.
Beteen the anterior and posterior canthal limbs lie the lacrimal punctum,
superior and inferior canaliculi, and superior one third of the lacrimal sac,
hich projects . to /mm above the level of the tendon. #he superior and
inferior canaliculi travel for a shaort distance vertically $approximately
/mm% before assumin! a more hori&ontal orientation $approximately /mm%
before assumin! a more hori&ontal orientation $approximately .0mm%. #hey
convera!e and form a common canaliculus that enters the nasolacrimal sac
at its posteroinferior third. #he nasolacrimal duct, hich is approximately
/0mm in len!th, travels vertically ithin the maxilla to open into the inferior
meatus of the nose at the anteriorly located lacrimal fold. #o!ether, these
structures are responsible for the collelction and draina!e of tears from the
conjunctival fornices into the inferior meatus of the nose. 1ama!e to any
portion of the system may lead to excessive tearin! from the eye, a condition
knon as epiphora.