Management of Significantly Displaced Nasal Bone Fractures
Closed reduction is the recommended first-line treatment for significantly displaced nasal bone fractures, with open reduction reserved for complex fractures or those with significant septal involvement. 1
Diagnostic Approach
CT maxillofacial scan is the preferred diagnostic modality for nasal fractures
Clinical assessment should focus on:
- Facial symmetry and nasal deviation
- Airway patency
- Presence of crepitus
- Mucosal tearing (statistically significant indicator of septal fracture) 2
Treatment Algorithm
1. Closed Reduction (First-Line)
Indicated for:
- Simple displaced fractures
- Fractures without significant septal involvement
- Recent fractures (ideally within 2 weeks of injury)
Procedure details:
- Can be performed under local or general anesthesia
- Often done in outpatient setting
- Involves manual manipulation to restore nasal bone alignment 1, 3
Outcomes:
- Studies show significant improvement in both functional and esthetic parameters 3
- High patient satisfaction rates measured by Visual Analog Scale 3
2. Open Reduction
Indicated for:
- Complex fractures
- Fractures with significant septal involvement
- Delayed presentation (>2 weeks post-injury)
- Failed closed reduction
Techniques:
- Can be performed through an intercartilaginous incision
- May require septoplasty or submucosal resection in cases with severe septal fractures 2
- For delayed-diagnosed fractures (11-39 days post-injury), open reduction through intercartilaginous incision has shown excellent results in 83% of cases 4
Special Considerations
Septal Fractures
- Present in up to 96.2% of simple nasal bone fractures 2
- Often unrecognized and untreated at time of injury
- Septoplasty or submucosal resection may be required in approximately 78.8% of cases with severe septal fractures 2
- The septum should be positioned into the midline using a transverse root osteotomy 1
Timing of Intervention
- Early intervention is preferred when possible
- For delayed cases (11-39 days post-injury), open reduction can still achieve excellent results 4
- Kirschner wire insertion may be necessary (33.3% of cases) for unstable reduced nasal bones in delayed repairs 4
Postoperative Management
Monitor for complications:
- Persistent nasal deformity
- Nasal airway obstruction
- Breathing difficulties
- Septal perforation 1
Follow-up with a specialist to monitor healing and address any developing complications
Treatment Efficacy
Studies demonstrate that closed reduction is highly effective for managing nasal bone fractures, with significant improvements in both functional and esthetic parameters 3. However, the high incidence of concurrent septal fractures (96.2%) highlights the importance of thorough evaluation and appropriate surgical planning 2.