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Trauma to the midface frequently results in complex fractures of the naso orbitoethmoid(NOE) skeleton that present the greatest diagnostic and therapeutic challenge in facial trauma reconstruction. These injuries are often misdiagnosed and inadequately treated because of the complex anatomy of this region. Treatment of these injuries, and early investigations focused on closed treatment using external nasal dressings after nasal manipulation. Open reduction with internal fixation (ORIF) has proved to be an important advance in the management of these fractures and, combined with proper reduction of the medial canthal tendon and primary nasal dorsum bone grafting, has improved the cosmetic result even in severe injuries.