NASAL BONE FRACTURE

PREPARED BY: DR. KANZA ATEEQUE (PGT OMFS)

 CONTENTS

 Introduction
 Types of nasal fracture
 Clinical features
 Diagnosis
 Treatment
 Postoperative care
 References
 INTRODUCTION

 Fractures of nasal bones are the most common trauma to the face
 Magnitude of force will determine the depth of injury
 Traumatic force may act from the front or side
 TYPES OF NASAL FRACTURE

Laterally
Laterally displaced with Posteriorly
displaced septal depressed
displacement
LATERALLY DISPLACED/ ANGULATED
NASAL FRACTURE
 LATERALLY DISPLACED/ANGULATED
NASAL FRACTURE

 Due to lateral blow

 May cause:
 Unilateral depression of nasal bone on the same side
 Fracture both nasal bones & septum with deviation of nasal bridge
 Nasal fractures are often accompanied by injuries of nasal septum (dislocated, or
comminuted)
 Most of them can be managed by closed reduction
POSTERIORLY DEPRESSED
NASAL FRACTURE
 POSTERIORLY DEPRESSED
NASAL FRACTURE

 Occur due to frontal blow

 Lower part of nasal bones (thinner), easily get fractured
 The nasal septum is always involved
 Severe frontal blow will cause “open-book fracture”  nasal septum will collapsed and
nasal bones splayed out
 Greater force  comminution of nasal bones and even the frontal process of maxillae with
flattening and widening of nasal dorsum
 This type of fracture can be associated with NOE fractures
Open-book fracture
 CLINICAL FEATURES

Swelling of
nose

Lacerations
Nasal
of nasal
obstruction
skin

Periorbital
Epistaxis
ecchymosis

Crepitus Tenderness

Nasal
deformity
 DIAGNOSIS

 Best made on physical examination using bimanual digital palpation

 Signs of nasal bone fractures- steps, humps and crepitus
 Intranasal examination should be done for ruling out septal deviation, laceration and septal
hematoma
 X-ray:
 may or may not show fracture
 Patient should not be dismissed as having no fracture because x-rays did not reveal it
 Should include occipitomental views (10 &45 degrees) and right & left lateral view.
 TREATMENT

1. OBSERVATION:
 Indications
 Non-displaced fractures without nasal deformities or airway obstruction
 Nondisplaced fractures of the nasal bone, nasal septum and anterior nasal spine
 No clinically relevant nasal deformities on physical examination
 No clinical evidence of airway obstruction
2. Closed reduction:
 Indications
 Displaced, unilateral or bilateral, nasal bone fractures
 Fractures of the nasal septal complex causing nasal airway obstruction

• Closed reduction should be performed as soon as the deformity is identified, preferably 10-14
days post injury, but may be possible up to 21 days
 Closed reduction of fractured nasal bone and septum is performed after achievement of hemostasis
 Under local anesthesia
 Instruments commonly used for closed treatment of nasal fractures are:
• Asch septum-straightening forceps
• Walsham septum-straightening forceps
• Boies nasal fracture elevator
• Mayo hemostat with rubber tubing
• Killian nasal septum speculum
Reduction of laterally displaced nasal fracture
Reduction of laterally displaced nasal fracture
Reduction of posteriorly depressed nasal fracture
Reduction of nasal fracture using Walsham forceps
3. Open reduction:
 Indications
 Unstable or dislocated nasal bone fractures
 Extensive fracture dislocation of the nasal bone and septum
 Fracture dislocation of the lower septum
 Open septal fractures
 Persistent deformity after closed reduction
 Inadequate bony reduction due to deformity
 Open reduction of fractured nasal bone and septum is performed after achievement of hemostasis
 Under General Anesthesia
 In case of severely comminuted or open fractures existing lacerations can be used for approaching the
fracture
 When associated with other facial fractures (eg, NOE, frontal sinus) the coronal approach can be used
 Otherwise, it depends on the surgeon's preference
 Reduction of the nasal bone using Lempert rongeur

Reduction of the nasal bone using Lempert rongeur

Reduction of cartilages
Midline repositioning of quadrangular cartilage of the
septum and the vomer
Grafting
POSTOPERATIVE CARE OF THE PATIENT

Postoperative positioning
 POSTOPERATIVE CARE OF THE PATIENT

 To prevent orbital emphysema, nose-blowing should be avoided for at least 10 days following NOE
fracture repair
 No aspirin for 7 days
 Analgesia as necessary
 Antibiotics
 Nasal decongestant may be helpful for symptomatic improvement in some patients
 Steroids, in cases of severe orbital trauma, may help with postoperative edema
 REFERENCES

 Fractures of the facial skeleton (2nd edition) by Peter Banks

 https://surgeryreference.aofoundation.org/cmf/trauma/midface/nasal-bone (AO-CMF)