FACIAL AND NASAL
TRUMA
Dr
Rasheed ali alsadoon
NASAL FRACTURES
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Relatively little force is required to fracture the nasal bones
Most fractures result from laterally applied forces (over 66%),fractures following frontal
injuries accounted for 13%,greater force is is required to fracture the nose with a blow
directed from the front as the nasal cartilages behave like shock absorbe
CAUSES
Physical fights,
assaults ,
domestic violence.
Contact sports
Falls (common in children)
Motor vehicle accidents
Falls from syncope or impaired balance in
the elderly and etc
Nasal fractures - classification
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Class 1 - frontal or frontolateral trauma- vertical septal fracture- depressed or displaced
distal part of nasal bones
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Class 2 - lateral trauma- horizontal or C-shaped septal fracture- bony or cartilaginous
septum fracture- frontal process of maxilla fracture
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Class 3 - high velocity trauma- fracture extends to ethmoid labyrinth- bony septum
rotates posteriorly- bridge collapse- upturned tip, revealing nostrils- depressed nasal
bones pushed up under frontal bones- apparent inter-ocular space widening
Clinical presentation
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History
Details of how injury was sustained
Nasal obstruction
Change in appearance
Epistaxis
Watery rhinorrhe
Visual disturbance
Diplopia
Epiphora
Altered bite
Loose teeth
Trismus
Examination
Deviation,depression,step deformity
Mobility,cripitus,tenderness
Generalized swelling
Skin laceration
Septal fracture,haematoma,abscess,perforation
Mucosal laceration
Investigation
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1-Plane x ray is controversial,not required to make the diagnosis
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2-ultrasound
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3-CT scan
Management
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fracture Nothing if no deformity. Reassure and review
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Class 1- reduce if early - disimpact and realign - if swollen, manipulate and reduce at 5-
7 days
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fracture Class 2- septal fracture is often overlapping so fractures redisplace -
manipulation of the nasal bones should follow excision of overlapping
edges Manipulation should not be delayed more than 10 to 14 days as fracture(s)
become “sticky” and fixed, making reduction difficult or impossible. It is also
inappropriate to try to reduce an old deformity as the attempt will rarely succeed
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- fracture Class 3- requires open reduction - depressed nasal bones need elevation and
support - septum is approached intranasally and reduced antero-inferiorly - malunion
will require formal septorhinoplasty at 4-6 months if requested
