Treatment of Anterior Nasal Spine Fractures
Most anterior nasal spine (ANS) fractures can be managed conservatively without surgical intervention, but displaced fractures causing functional symptoms or significant pain require open reduction and internal fixation. 1
Initial Diagnostic Approach
Obtain CT imaging with thin-slice bone windows and 3D reconstruction to accurately diagnose ANS fractures, as the missed diagnosis rate exceeds 95% on standard imaging due to unfamiliarity with this anatomical structure. 2 The ACR recommends CT maxillofacial imaging as the primary modality for evaluating facial trauma, providing superior delineation of osseous structures and multiplanar reconstructions for characterizing complex fractures. 3
Key Clinical Features to Assess
- Pain localized to the nasolabial angle region, particularly aggravated by upper lip closure 1
- Tenderness on palpation over the anterior nasal spine 1
- Caudal septal deviation causing nasal obstruction, which occurs when ANS displacement affects the septum 4
- Degree of displacement on CT imaging, as this determines treatment approach 1
Treatment Algorithm
Non-Displaced or Minimally Displaced Fractures
Conservative management is appropriate for fractures without significant displacement or functional impairment:
- Analgesics for pain control as needed 1
- Soft diet for 2 weeks to minimize stress on the fracture site 1
- Clinical reassessment at 4-6 weeks to evaluate healing and functional outcomes 5
Displaced Fractures with Functional Symptoms
Surgical intervention with open reduction and internal fixation is indicated when:
- Overt displacement is present on CT imaging 1
- Persistent pain with functional activities (eating, speaking, facial expression) 1
- Caudal septal deviation causing nasal obstruction 4
The surgical approach involves:
- Open reduction and internal fixation under local or general anesthesia 1
- ANS relocation technique when caudal septal deviation is present, which achieves complete septal straightening in 82.5% of cases and significant improvement in 17.5% 4
- Regular diet can be resumed within 2 weeks postoperatively 1
Anatomic Considerations Affecting Fracture Risk
Double rod and single rod morphologies of the ANS are significantly more prone to fracture (33.85% and 32.26% respectively) compared to triangular configurations (12.24%), while irregular types rarely fracture. 2 This anatomic variation should be noted on imaging as it may influence treatment planning and patient counseling.
Expected Outcomes
Surgical treatment of displaced ANS fractures results in complete symptom resolution with return to normal function within 2 weeks and no reported complications in case series. 1 For ANS relocation procedures addressing caudal septal deviation, 92.9% of patients experience significant subjective improvement in bilateral nasal airflow, with no patients experiencing worsened airflow postoperatively. 4
Critical Pitfalls to Avoid
- Failing to obtain thin-slice CT with bone reconstruction leads to missed diagnosis in over 95% of cases 2
- Dismissing vague nasal discomfort without palpating the nasolabial angle region may miss symptomatic displaced fractures 1
- Delaying surgical intervention beyond 2-3 weeks may result in malunion requiring more complex secondary reconstruction 6
- Not assessing for associated nasal bone fractures, which commonly occur with ANS injuries and may require concurrent closed reduction 7, 6