ResidentTraumaFINALhighres

II. Nasal Bone Fractures

A. Introduction

Nasal fractures are a commonly encountered, and often isolated, form of

facial fractures. The prominence of the nose on the face makes it the

common recipient of injury. Despite the frequency in which nasal fractures

are encountered, the consulting surgeon may be confused regarding which

approach is best applied to a given patient. Choices range from no treat-

ment at all, to extensive and comprehensive techniques applied in the

operating room involving maneuvers used in septorhinoplasty. The timing

of treatment may be just as confusing, as patients and referring physicians

often expect for the consulting otolaryngologist to “set” the presumed

broken nose immediately, when the actual extent of fractures and even

deformity present may not be fully evident upon presentation. The

following outline presents a guideline that resident physicians in otolaryn-

gology–head and neck surgery may use to make sound decisions and to

build practice patterns that can be refined with experience.

B. Reviewof Anatomy

1. Bony: Paired Nasal Bones (Figure 4.8)

Maxillafrontal processes laterally.

Premaxilla inferiorly.

Maxillary crest internally.

Ethmoid-perpendicular plate.

Lamina papyracea.

Paired lacrimal bones.

Nasal process of frontal bone.

2. Cartilaginous (Figure 4.8)

Quadrangular (septal) cartilage.

Paired upper lateral cartilages, contiguous with septal cartilage

dorsally.

Paired lower lateral (alar) cartilages, with medial and lateral crura

(“legs”).

Sesamoid accessory cartilages

(variable).

Figure 4.8

Nasal bony and

cartilaginous anatomy.