Nasal fractures most commonly occur as a result of blunt facial trauma sustained in events such as motor vehicle accidents, sports-related injuries, assaults and falls. In fact, the nasal bones are the most frequently fractured facial bone and tend to peak in incidence during the second and third decades of life with a male predominance.
In a basic sense, the external nose is made up of bone (the upper third of its structure) and cartilage (the lower two thirds). In addition, the nasal septum (wall between right and left nasal cavities) is also made up of both cartilage and bone.
Isolated nasal fractures are defined as fractures of the nasal bones without involvement of the surrounding structures. It is important to realize, however, that even in isolated nasal fractures, there can be involvement of the nasal cartilages and septum. In fact, as the nasal injury becomes more severe, the frequency of septal fractures increases to as high as 96%. It is important for your physician to recognize this since an unreduced (untreated) septal fracture is widely accepted as the most common cause of a residual deformity after treatment.
Nasal fractures can occasionally coincide with fractures of the surrounding bone including the nasomaxillary buttress, Le Fort pattern injuries (types 2 and 3), naso-orbitoethmoid complex (NOE) and frontal sinus. This is extremely important to identify since these cases most likely will require more complex surgical repair consisting of an open reduction and internal fixation.
Treatment Options
Options for treatment generally fall into one of four categories –
- Observation
- Closed Reduction
- Closed Reduction with septoplasty
- Open Reduction with or without internal stabilization
An increased degree of intervention is required as we progress down these treatment options. Often, a more severe injury will require a more involved approach for treatment. The major goals of treatment to re-establish pre-injury nasal form and function. This means that we aim to make your nose look as close to it did before the injury as well as optimize nasal breathing.
It is also important to realize that a secondary procedure may be required in the future to further achieve these aims. Often, this will require a septorhinoplasty that further aims to restore your pre-injury state.
Why choose Dr. Gupta?
As a facial plastic surgeon, Dr. Gupta is extensively trained not only in nasal fractures but in the diagnosis and treatment of fractures of the entire maxillofacial skeleton. In addition, he has undergone dedicated and thorough study of principles in both functional and aesthetic nasal surgery.
The nuance in managing these injuries is identifying those patients who might need something more extensive than a simple closed nasal bone reduction at the outset. This generally requires a complex consideration of multiple factors, including many mentioned in this post. A special group of patients are those who had a nasal fracture many months or years ago but are now bothered by external deviation or nasal obstruction. Dr. Gupta offers advanced techniques to achieve significant improvements in these factors that stand the test of time.
