Fracture of Nasal bone
Bahoz Himdad Majeed
Classification
1- Frontal injuries:A- Plane 1- lower end of nasal bone and anterior nasal spine.
B- Plane 2- External bone.
C- Plane 3- Nasoethmoidal injury.
2- Lateral injuries:
A- Without septal fracture.B- With septal fracture.
Clinical Features
Nasal deformity.Nasal bone crepitus.
Brusing and edema.
Blood clot and bony fragments in the nasal passage.
Mucosal tears and damage to nasal septum may present.
Radiographic Evaluation
1- Lateral views of nasal bone, 15 or 30 degree occipitomental projections can be taken.2- CT scan for higher level of nose fractures.
Reduction
Closed Reduction is the treatment of choice for most nasal bone and/or septal fracture, these fractures should be repaired within 7 to 10 days, can be done under LA with or without sedation or GA.Use of left and right Walshm`s forceps to manipulate nasal bone at frontal process of maxillae.
Asches septal forceps to iron out nasal septum and to elevate the nasal bridge.
Sub mucosal resection(SMR) technique should be reserved for the patient who exhibits airway obstruction due to distorted septum.
Inter nasal immobilization
Ribbon Gauze.BIPP.
Whitehead varnish.
Silastic implant and stainless steel inter nasal splint
External fixation
Plaster of paris splint.Gauze and soft metal sheet ( Tin / Lead Alloi ).
Thermoplastic splint.
Cmpression plates.
