<![CDATA[Background: Naso-orbito-ethmoid (NOE) fractures are complex midfacial injuries that are frequently underdiagnosed, particularly when presenting with clinical features similar to isolated nasal bone fractures. Overlapping symptoms such as epistaxis, nasal deformity, and periorbital edema often obscure the true extent of injury during initial emergency assessment. Objective: This study aims to highlight the diagnostic challenges of NOE fractures through a three-case series and a narrative literature review, with emphasis on the importance of early recognition of key clinical signs, especially telecanthus. Methods: Three patients presenting with maxillofacial trauma initially diagnosed as nasal bone fractures were evaluated. Clinical findings, imaging results, and management approaches were analyzed. A narrative literature review was conducted using major databases to identify studies discussing NOE fractures, misdiagnosis, and diagnostic strategies. Results: All cases demonstrated initial misdiagnosis due to nonspecific clinical features. Computed tomography (CT) with three-dimensional reconstruction revealed complex fracture patterns involving adjacent midfacial structures. Key indicators such as telecanthus and multi-structural involvement were frequently overlooked at initial evaluation. Conclusion: Early and accurate diagnosis of NOE fractures requires high clinical suspicion, comprehensive examination, and prompt CT imaging. A systematic and multidisciplinary approach is essential to reduce misdiagnosis and improve clinical outcomes.]]>
