Nasal Fracture: Concerns of Function and Feature

The nose is the most common facial feature to sustain a fracture. Sequalae of such injuries result in deformities affecting the outside and inside structures of the nose, which can cause complicated breathing, sinus infections, nose bleeds, snoring, nasal obstruction and distorted facial features. The facial surgeon is concerned with septal and dorsal hematomas; deviated, impacted septum's; crooked nasal bones; cheek, orbit and jaw fractures; and soft tissue lacerations. Findings of trauma-induced nasal fractures and associated injuries are often subtle. Actual deformity is better ascertained through a full clinical assessment several days after injury, once swelling is decreased, and involves history, physical examination as well as consideration of nasal features prior to injury and force of injury. Type and severity of fracture are assessed by looking at the mechanism of injury. Mild forces may only cause unilateral nasal bone depression; severe blows result in bilateral fractures with septal disruption; and frontal blows cause impaction injuries. Diplopia, trismus facial hypothesia, severe bruising and pseudotelecanthus of the eyes may indicate severe injury requiring further radiologic workup and CT scan. Septal hematoma may be indicated if nasal drainage is disproportionate to injury. Hematomas, though rare, require emergency drainage. Cartilage is stripped of its nutrient blood supply and sequestered, resulting in scarring, collapse of the septum and dorsum and, ultimately, obstruction and collapse of the nose.

Orbital injuries require an ophthalmologist to assess for a globe injury. CT scans aid in diagnosing orbital, malar and midface fractures. Displacement, trismus and persistent diplopia are associated with some fractures and require reduction. Most displaced nasal fractures require simple septorhinoplasty to restore shape and function of the nose. Such procedures allow the best hope at obtaining an excellent aesthetic and functional complete result. Because children's noses contain more cartilage, fractures are less frequent. Treatments are conservative to prevent damage to growth plates of the cartilage and bone. Severe deformities are conservatively reduced nonetheless to encourage straight growth of the septum and nose during growth spurts. The Otolaryngologist (ENT) has 5 to 7 years of specialty training in surgical and medical problems of the head and neck. This surgeon can determine whether a patient requires immediate treatment and is adept at state-of-the-art techniques minimizing the need for packing, reducing bruising and discomfort during recovery. In most cases, through open reduction of fractures, the surgeon achieves excellent aesthetic results and restoration for the nasal airway. Treatments are preformed under quick IV sedation or general anesthesia on an outpatient basis.