Definition

Nasal bone fractures are among the most common fractures in the midfacial area. They are mostly caused by blunt force (e.g. hit, fall), which hits the nose from the front or the side. Depending on the intensity of the effective force, the cartilaginous and/ or the bony structures collapse.

If the effective force is big, not only the nasal bone is fractured but also the maxilla processes, which are involved in forming the nasal bone. The nasal septum is always involved in the fracture.

Therapy Goals

The therapy goal is the restoration of form and function of the nose as well as of the paranasal structures. Through immediate intervention, a possible infection is prevented and the healing period reduced.

Therapy Indications

Clinical and/ or radiological evidence of a dislocated fracture in the area of the nasal bone and/ or the septum
Septal haematoma
Septal deviation
Nasal air passage obstruction
Anosmia
Xenolith
Dysfunction of the lacronasal duct
Drainage dysfunction of the frontal sinus
Epistaxis

Examinations
Inspection
Palpation
X-rays
Computer tomography
Liquor test

Therapy

Conservative Therapy
Closed fractures and fractures without dislocation do not require therapy.
If indicated, nasal support bandage

Surgical Therapy
Closed Repositioning
A closed reposition is required in dislocated fractures, furthermore in splintered fractures and in case of medical contra-indications to an open reposition.

Open Repositioning
An open reposition of the nasal bone/ septum is required in case of:

-          fractures, which cannot be reduced through a closed repositioning
-          piercing of bone fragments or perforated soft tissue injuries
-          fractures which require immediate reconstruction with bone transplantation
-          associated injuries of the face and/ or neurocranium, where the operative access can be used

Additional Measures
If indicated, antibiotic therapy
Analgesic therapy
Ordering the patient not to blow his/ her nose
Splinting (inner, outer)
Haemostatic tamponade

Recommendation

Depending on the severity of the injury the treatment is performed outpatient or in hospital.

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