Surgical Management of Bilateral Nasal Bone Fractures
Surgery for bilateral nasal bone fractures should be performed within 7-10 days after injury for most cases, with immediate intervention required only for open fractures, septal hematomas, or grossly displaced fractures. 1, 2
Indications for Surgical Intervention
Immediate Surgical Repair (Within 24-48 Hours)
- Open fractures requiring debridement and repair 1
- Presence of septal hematoma (to prevent cartilage necrosis) 2
- Grossly displaced fractures causing severe functional or cosmetic deformity 2
Early Surgical Repair (Within 7-10 Days)
- Most closed nasal bone fractures should be treated after initial edema subsides (3-10 days) 2
- Complex fractures with septal deviation require positioning the septum into midline using transverse root osteotomy 1
- Comminuted fractures may require camouflaging techniques such as dorsal onlay grafts 1
Delayed Surgical Repair
- Patients with persistent nasal deformity or functional issues after initial healing 3
- Pediatric patients can achieve excellent results even with delayed reduction (more than 7 days after trauma) 4
Diagnostic Approach
- CT imaging is the preferred diagnostic modality for nasal fractures, offering superior detection compared to conventional radiography 1
- Conventional nasal radiographs have limited diagnostic value (accuracy 53-82%) 1
- Ultrasound may be considered as an alternative with high accuracy (sensitivity 90-100%, specificity 98-100%) 1
Surgical Technique Considerations
- Minimize destabilization of the osseous nasal framework by preserving periosteal and mucosal attachments 5
- Use the smallest possible manipulative force necessary to achieve reduction 5
- For cases with associated septal deviation, additional septal correction is required to achieve both functional and aesthetic improvement 5
- Place a strut between the medial crura for support and realignment in complex fractures 1
Outcomes and Follow-up
- Immediate post-operative CT scans can help determine whether secondary adjustment is necessary 3
- Incompletely reduced nasal bones may show spontaneous improvement in bony arrangement over time 3
- Patient satisfaction rates of 77.5% for breathing and 85.6% for cosmesis can be achieved with proper management 6
- Approximately 11% of patients may require subsequent septorhinoplasty despite initial reduction 6
Special Considerations
- Short nasal bones are a relative contraindication for osteotomies due to risk of bony communication 1
- Associated septal injuries can lead to postoperative nasal deformity and obstruction, requiring additional correction 1
- Visible irregularities or step-off deformities may occur in areas with thin overlying skin 5
- Patients without septal injury have significantly better postoperative outcomes 4
Common Pitfalls to Avoid
- Attempting reduction while significant edema is present (except in cases requiring immediate intervention) 2
- Relying solely on conventional radiographs for diagnosis 1
- Failing to address associated septal deviation during nasal bone reduction 1, 5
- Overlooking the need for follow-up evaluation to assess for delayed complications 3