What is the treatment for a nasal cartilage fracture?

Treatment of Nasal Cartilage Fractures

Surgical correction is the definitive treatment for nasal cartilage fractures, with specific techniques determined by the location and severity of the fracture to prevent long-term functional and cosmetic complications. 1

Diagnostic Approach

The first step in treatment involves proper diagnosis through:

• Clinical examination: Assess for external nasal deformity, nasal airway patency, point tenderness, mobility/crepitus of nasal bones, and septal hematoma or deviation 2
• Imaging: CT is the gold standard for complex nasal injuries, while ultrasound offers an excellent radiation-free alternative with 90-100% sensitivity for isolated nasal fractures 2
• Immediate complications assessment: Check for septal hematoma which must be evacuated immediately to prevent cartilage necrosis and saddle nose deformity 2, 3

Treatment Algorithm Based on Fracture Location

1. Septal Cartilage Fractures

• Mild deviations:

  • Mobilization, trimming/thinning and suturing to bring the posterior septal angle to midline
  • Fixation with permanent 5-0 nylon or PDS 4-0 sutures 1

• Moderate deviations:

  • "Contralateral subluxation locking" technique for slightly bowed, unilaterally deviated caudal septum
  • Repositioning of caudal septum to contralateral side of nasal spine/maxillary crest
  • Additional suturing to maintain position 1

• Severe deviations:

  • Weakening procedures: through-and-through cartilage incisions or castellation (interdigitating incisions)
  • Reconstruction with "figure 8" sutures to stabilize adjacent cartilage
  • Batten type grafts to reorient and straighten dorsal and caudal septal struts 1
  • Consider absorbable plates (PCL mesh or PDS) as internal splints for septal support 4

2. Upper Lateral Cartilage Injuries

• Recognize avulsion injuries which may cause significant concavity and "hollowed out" appearance
• Realign the lateral cartilage to its normal anatomical position to prevent airway obstruction
• Secure with sutures to prevent healing in a distorted position 5

3. Complex Nasal Cartilage Injuries

• Open approach for severe deformities
• Segmental reconstruction using combination of bone and cartilage grafts
• For dorsal defects: cranial bone graft for the upper two-thirds with cartilage component for the lower third 6
• Septal cartilage grafts provide better structural support than conchal cartilage when reconstruction is needed 7

Timing of Intervention

• Acute phase (within 1-2 weeks): Optimal timing for initial reduction and repair
• Early intervention (within 4 weeks): Critical for best correction of deformities 7
• Delayed treatment: May require more extensive reconstructive surgery for functional and cosmetic problems 3

Common Pitfalls to Avoid

1. Missing septal hematomas: Must be evacuated immediately to prevent cartilage necrosis and saddle nose deformity 2
2. Inadequate treatment of septal fractures: Can lead to nasal obstruction and post-traumatic deformity 4
3. Overlooking associated injuries: Nasal fractures may be part of more extensive facial trauma 2
4. Relying solely on radiographs: Poor sensitivity and does not alter management 2
5. Aggressive morselization: Increases risk of absorption and makes revision difficult 1

Special Considerations

• Even with proper treatment in the acute phase, cartilage often heals with some deviation 3
• Consider follow-up evaluation at 10 days, 1 month, and 3-6 months post-treatment 7
• Functional and cosmetic problems may require later reconstructive surgery 3