Nasal fractures

1. FRACTURES OF THE NASAL
BONE
PRESENTED BY:
MONIKA SAHAY
BATCH-2011

2. CONTENTS
 INTRODUCTION
 SITES OF INJURIES
 SYMPTOMS
 CAUSES
 DIAGNOSIS
 MANAGEMENT
 REFRENCES

3. INTRODUCTION
 Disruption or break in the
continuity of bone structure is
referred as fracture.
 A nasal fracture is commonly
referred as a broken nose.
 Fractures of nasal bones are the
most common trauma to the face
because of the projection of nose
on the face.
 Nasal fracture is usually the result
of direct injury with other facial
fractures.
 Fractures of the nasal bones and
septal cartilage result in not only
cosmetic deformity, but also
functional disturbances.

4. SITES OF INJURIES
ANTERIOR
INJURIES LATERAL
INJURIES

5. ANTERIOR
INJURIES
1.Anterior injuries involves fractures
of bridge of the nose, frontal
process, lacrimal bones, and
the septum.
2.Comminuted fragments may be
driven laterally into the orbit
or upward into ethmoid region.
3.Direct, violent, and/
or anterior force may
result in smash
fracture of anterior
bone.

6. LATERAL INJURIES
1.Lateral injuries involve only
one nasal bone with medial
displacement.
2.In severe case, a violent blow
from side results in fracture of
both nasal bones and fracture
of nasal septum with lateral
shifting of entire bony framework.
3.This type of fracture is called “open book” fr

7. OPEN BOOK FRACTURE
4.There is collapse of the nasal septum
with splaying out of the nasal bone like
pages of an open book.
5.There may be telescoping or
overlapping of fragments seen.

8. CAUSES
 Nasal fractures are caused
by:
- Physical trauma to the face.
-Common sources of nasal
fractures include:
Sports injuries
Fighting
Falls
Car accidents
Falls from syncope
Or impaired balance in the
elderly.

9. FIGHITING
CAUSES
INJURY DURING SPORTS
FALLS

10. WHAT DOES A NASAL
FRACTURE LOOK
LIKE?
LATERAL INJURY

11. SIGNS AND SYMPTOMS
OF A NASAL FRACTURE
 Nose pain
 Swelling of the nose
 Nosebleed
 Bruising around the nose
and the eyes
 The nose is bent
 A grating feeling when nose
is touched
 Blocked passages
 Nasal airway obstruction
 Nasal deformity

12. DIAGNOSIS
 On clinical evaluation nasal
deformities like depressed
bridge of the nose, flattening or
deviation of the nasal bone is
seen.
 In fresh fractures, edema,
hematoma, lacerations,
subconjuctival hemorrhage is
seen.
 Subcutaneous emphysema
may be present, because of
patient’s repeated attempts to
blow the nose.
 Circumorbital ecchymosis
 CSF rhinorrhoea may be

13. CLINICAL FEATURES
DEPRESSED BRIDGE
OF NOSE DEVIATED NOSE
SUBCONJUCTIVAL
HEMORRHAGE
CIRCUMORBITAL
ECCHYMOSIS

14. RADIOGRAPHIC
EVALUATION
 Lateral views of the nasal
bones,15° or 30°
occipitomental projections
can be taken.
 A lateral view taken with
small dental film against the
side of the nose also
provides excellent detailed
study.
 CT scan is helpful for higher
level fractures of the nose.

15. OCCIPITOMENTAL VIEW

16. MANAGEMENT
 Minor nasal fractures maybe
allowed to heal on their own
provided there is no
significant cosmetic
deformity.
 Closed reduction is the
treatment of choice for most
nasal bone and/ or septal
fractures.
 Closed reduction can be
done under LA with or
without sedation or general
anesthesia.

17. Closed Reduction:
- It refers to manipulation of
the bone fragments without
surgical exposure of the
fragments.
-This allows the bone to grow
back together.
-It is carried under local
anesthesia or general
anesthesia. For manipulating
the fragments Walsham’s
and Asch’s forceps are used.

18.  -Interfered by presence of
oedema.
 -Best time is before the
appearance of oedema, or after
it has subsided
(usually5-7days).
 -Difficult after 2 weeks because
it heals by that time.

19. CLOSED REDUCTION AND
SEPTAL REDCUTION
INWARD ROTATION OF
LEFT NASAL BONE.
HORIZONTAL SEPTAL
WALL FRACTURE
BILATERAL
COMMINUTED
DISPLACED AND
DEPRESSED NASAL
FRACTURES
ASCH FORCEPS WERE
USED TO MANIPULATE
SEPTUM INTO A
STRAIGHTER
POSITION, BUT NOT
ENTIRELY SYMMETRIC.

20.  At the end, internal
stablization is done with
nasal packing using half inch
ribbon gauze saturated with
antibiotic ointment.
 The pack is removed after 3
to 4 days.
 The external dressing
consist of padding the area
with cotton wool or gauze
pieces and stablizing it with
adhesive tape in “butterfly”
manner, secured to the
forehead and crossing over
the nasal bridge on either
side.
 Airway can be maintained

21. METHODS OF
IMMOBLIZATION
 Splinting may be required for
immobilization.
1.INTRANASAL SPLINTING:
 Ribbon gauze
 Stainless steel splint
Use of ribbon gauze is the most
standard method of providing
intranasal support.
A 1” ribbon gauze of 12-15cm length
is taken and inserted in nose, in
layers.
-Inadequate anteroposterior support.
-Difficulty in breathing from nose
-Potential source of infection
DISADVANTAGE:

22. EXTRANASAL SPLINTING
 Plaster of Paris
 Lead splints
-The most commonly employed
extranasal splint is the Plaster of
Paris.
-This consist of eight layers of
Plaster of Paris splint bandage
which is cut so as to produce a
strip of plaster across the bridge
on either side of the nose along
with frontal extension.
-The plaster should be moulded in
shape of the nose, and it should
not extent on to the soft part of the
nose.
-This is left in place for 1week.

23. -In case of mobile fracture which
cannot be stablized with plaster
of paris, lead plates can be used
on either side of the nose.
-These lead plates consist of two
holes and are fitted on each side
of the nose with help of tantalum
or stainless steel sutures which
are passed into the holes and
beneath the nasal bone.
-The splint is left in place for a
period of 3 weeks.

24. SPLINTING DONE WITH PLASTER OF PARIS
(A) LEAD PLATES, AND (B) SPLINTING
(B) DONE WITH LEAD SPLINTS

25. OPEN REDUCTION
 INDICATION FOR OPEN
REDUCTION:
-Extensive fractures
-Deviation of the nasal
pyramid greater than one
half width of the nasal
bridge.
-Open septal fracture
-Persistent deformity after
closed reduction.

26. COMPLICATIONS
EARLY
 Epistaxis is common with nasal
fracture and may recur with
reduction.
 Hematoma is always a concern
and must be excluded for each
patient.
 CSF rihnorrhoea is uncommon but
may occur when fractures extend
to include the cribriform plate.
LATE
• Nasal obstruction
• Secondary nasal deformity
• Saddle nose deformity
• Synechia
• Septal perforation

27. -TEXTBOOK OF ORAL
AND MAXILLOFACIAL
SURGERY- Dr. Neelima
Anil Malik
-TEXT BOOK OF ORAL
AND MAXILLOFACIAL
SURGERY
-SM BALAJI
BIBLIOGRAPHY

28. THANK YOU