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| IMC Wiki | Fractures of nasal bone

Fractures of nasal bone

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Definition

Central midface fractures include fractures of the Le Fort I and II planes, as well as midface comminuted fractures and fractures of the nasal bone

Examinations

Clinical examinations

Inspection

Symptoms:
  • Bilateral periocular haematoma
  • Subconjunctival haemorrhage
  • Swelling
  • Saddle nose
  • Scoliotic nose
  • Septum hematoma
  • Septum deviation
  • Nosebleed (epistaxis)
Palpation
  • Fracture difficult to palpate
  • Painful
Function tests
  • Olfactory nerve
  • Air passage

Radiographic examinations

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Basic examinations
  • Paranasal sinuses
  • Lateral skull
  • Nasal bone, special
Further examinations
  • CT

Indications for therapy

  • Profuse bleeding from nose
  • Dislocated fracture
  • Functional deficits
  • Nasal deformity
  • Septum deviation

Therapy

Conservative therapy

No specific therapy is required in closed non-dislocated nasal fractures; if useful, nasal cast and tamponade


Surgical therapy

Closed repositioning

Closed repositioning is indicated in dislocated fractures, in splintered fractures, and in the presence of systemic contraindications against open repositioning.

Open repositioning

Open repositioning of nasal bone/septum fractures is indicated in the following situations:
  • Fractures not allowing closed repositioning
  • Pierced bone fragments or perforating soft-tissue injuries
  • Fractures requiring immediate reconstruction with bone grafts
  • Surgical treatment of associated facial or neurocranial trauma, making use of the same surgical access (see polytrauma)
  • Access usually by coronal incision or butterfly incision, intranasal access for septum fractures

Additional measures

  • Pain therapy
  • No blowing of nose
  • Splinting (internal, external)
  • Haemostatic tamponade
  • Antibiotic therapy, if required

Risk factors

  • Soft-tissue defect
  • Loss of bone fragments
  • Comminuted fractures
  • Foreign-body penetration
  • Contaminated wound
  • Infection

Complications

  • Persistent deformity
  • Soft-tissue loss
  • Chronic infection of paranasal sinuses
  • Nasolacrimal duct dysfunction
  • Airway obstruction
  • Septum perforation