Nasal bone fractures are the most common type of facial fractures, accounting for ~45% of facial fractures, and are often missed when significant facial swelling is present.
Unsurprisingly, nasal bone fractures occur when the nose impacts against a solid object (e.g. fist, forehead, dashboard, etc). Lateral impact injuries are the most common type of nasal injury leading to fracture.
Nasal bone fractures when isolated are most commonly a displaced fracture of one the paired nasal bones. There is often association with other facial fractures and this requires careful assessment 3,5:
- nasal septum
- orbital blow-out fracture
- frontal process of the maxilla
Nasal septal haematoma should also be actively assessed for.
It should be noted that cartilaginous injuries cannot be detected radiologically and that imaging of simple nasal bone fractures often add little to patient management. However, imaging can be useful in documentation, assessing extent and associated facial fractures and/or complications 5.
- sensitivity ~80% 6
- best detected on lateral view
- Waters view is useful in assessing the nasal arch 4
- sensitivity is 100% 6
Treatment and prognosis
Treatment depends on the degree of displacement. If alignment is essentially anatomical then no treatment is required. If displacement is significant then if untreated they may result both in unfavourable cosmetic result and in impaired function (i.e. difficulty in breathing through one or both nasal passages). Untreated nasal fractures account for a high percentage of rhinoplasty and septoplasty procedures.
The worst morbidity results from septal haematoma, leading to nasal septal perforation and necrosis, which causes severe nasal collapse and deformation.
- longitudinally-orientated fractures may be confused for the nasomaxillary suture and/or nasociliary groove
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- 2. Atighechi S, Karimi G. Serial nasal bone reduction: a new approach to the management of nasal bone fracture. J Craniofac Surg. 2009;20 (1): 49-52. doi:10.1097/SCS.0b013e318190def5 - Pubmed citation
- 3. Kucik CJ, Clenney T, Phelan J. Management of acute nasal fractures. Am Fam Physician. 2004;70 (7): 1315-20. Pubmed citation
- 4. Dolan K, Jacoby C, Smoker W. RadioGraphics. 1984;4 (4): . doi:10.1148/radiographics.4.4.577
- 5. Brant WE, Helms C. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. (2012) ISBN:1608319113. Read it at Google Books - Find it at Amazon
- 6. Baek HJ, Kim DW, Ryu JH et-al. Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability. Iran J Radiol. 2013;10 (3): 140-7. Free text at pubmed - Pubmed citation