Septal Fracture in Simple Nasal Bone Fracture

Abstract

Nasal bone fractures are the most common type of facial fractures. Previous studies have shown that most nasal fractures involve the septum, which can provide an obstacle to the successful reduction of nasal bone fractures. In particular, septal fractures in combination with simple nasal bone fractures are usually unrecognized and untreated at the time of injury. Furthermore, systemized treatment protocols and diagnostic tools for septal fractures in the case of simple nasal bone fracture have not previously been presented. In this study, the clinical findings of septal fractures in cases of simple nasal bone fracture were correlated with symptoms, signs, and computed tomography findings and assessed statistically. The patterns of septal fractures in simple nasal bone fractures were assessed by direct vision via hemitransfixion incision. Of the 52 patients with simple nasal bone fracture who presented over a 3-year period and were included in this study, 10 were female and 42 were male, with an average age of 33.8 years (age range, 18 to 61 years). Fifty of these patients (96.2 percent) showed septal fractures, and septoplasty or submucosal resection was performed on 41 patients (78.8 percent) who manifested severe septal fractures of perioperative septal grade 3 or higher. Closed reduction of the nasal bone fracture only was performed on the remaining 11 patients. Among the signs evident at physical examination, mucosal tearing was found to be statistically significant for septal fracture. Computed tomography was found to be very helpful in diagnosing septal fracture but could not predict its severity accurately (Spearman correlation coefficient between computed tomography septal grading and perioperative septal grading, 33.5 percent). Therefore, computed tomography could not be used as a definitive diagnostic modality for septal fractures in terms of deciding whether septoplasty or submucous resection was needed. It is evident that septal fractures are frequent in simple nasal bone fractures that are not combined with other facial bone fractures. This study confirms that there are differences between radiologic findings and perioperative findings. To reduce the incidence of posttraumatic nasal deformity, meticulous physical examinations with subsequent septoplasty or submucosal resection are needed in the treatment of simple nasal bone fracture.

Clinical Analysis of Midfacial Fractures

“…This is because the zygoma is a prominent bone structure in the midface and therefore susceptible to various types of impact (15,19). Although nasal bone fractures are also considered common midfacial fractures (28,29), only 2 isolated factures of the nasal bone were observed. This was probably because most patients with nasal bone fractures were treated in Otolaryngology and seldom consulted Oral and Maxillofacial Surgery.…”

Nasal trauma: Primary reconstruction with open rhinoplasty

“…Another factor supporting early rhinoplastic procedures is the technical difficulties that surgeons must face regarding revision rhinoplasty for a traumatic nasal deformity (4,6,13). Thus, adequately identifying and optimizing the initial treatment of the nasal complex fractures is key in decreasing the need for secondary surgery.…”

“…A fractured septum should be considered a significant factor, which can unfavourably affect the alignment of the nasal bone during the healing process (13).…”

Nasal Bone Fracture Detected by Bedside Emergency Department Ultrasonography

“…Nasal bone fractures are the most common types of facial fractures (1). Blunt trauma such as motor vehicle accidents, sports injuries, and physical altercations are the most common causes (2).…”