Can nasal trauma cause the nose to become flatter?

Can Nasal Trauma Cause the Nose to Become Flatter?

Yes, nasal trauma can absolutely cause the nose to become flatter through several mechanisms including nasal bone depression, septal collapse, and specific fracture patterns that result in loss of nasal projection and structural support.

Mechanisms of Nasal Flattening from Trauma

Direct Structural Collapse

Trauma can cause immediate flattening through:

• Naso-orbital-ethmoid (NOE) fractures result from trauma to the upper nasal bridge, causing the nasal bones, medial orbital walls, nasal septum, and naso-frontal junction to fracture, leading to "telescoping of the nose"—a literal flattening and shortening of nasal projection 1
• Depression or displacement of nasal bones occurs commonly after blunt trauma, with the nasal bones being susceptible to injury as the most prominent facial structure 2, 3
• Septal cartilage injuries can arise even after minor trauma without concomitant nasal fracture, resulting in nasal/septal deformation and saddle nose deformity if not properly treated 4

Secondary Deformities

Even when initial trauma seems minor, progressive flattening can develop:

• Cartilaginous overgrowth occurs on the dominant side over time after septal deviation from trauma, progressively worsening the deformity 1
• Poorly addressed structural injuries lead to posttraumatic nasal deformity requiring subsequent rhinoplasty in as many as 50% of cases, indicating that initial trauma frequently results in permanent structural changes 5
• Septal hematomas and abscesses, if not urgently drained, can result in saddle nose deformity through cartilage necrosis 2, 4

Critical Clinical Considerations

Etiology and Timing

• Trauma is the most common etiology of deviated septum, whether intrauterine, during birth, or postnatally, with the degree of trauma required for clinically significant deviation inversely related to the patient's age 1
• There is a two-week window before displaced nasal bones start uniting, making timely intervention critical 2
• Immediate nasal reconstruction is ideal when medically possible because this decreases long-term sequelae and prevents permanent flattening 3

Age-Specific Vulnerabilities

• Children are particularly vulnerable to growth disturbances from nasal trauma, with septal deformations often followed by deformation of the nasal pyramid (rhino scoliosis, rhino lordosis) 6
• Younger patients require less force to produce clinically significant deviation and subsequent deformity 1

Common Pitfalls to Avoid

• Failing to exclude septal hematoma during initial assessment, which requires urgent drainage to prevent cartilage necrosis and saddle nose deformity 2
• Dismissing "minor" trauma without thorough clinical examination, as cartilaginous injuries can occur without nasal fracture and still result in significant deformity 4
• Delaying treatment beyond the two-week window, after which surgical correction becomes significantly more complex 2
• Inadequate initial treatment of nasal fractures, which commonly leads to secondary deformities requiring subsequent rhinoplasty 5

Functional and Cosmetic Impact

The flattening from trauma affects both appearance and function:

• Loss of nasal projection creates cosmetic deformity that adversely affects patient self-image and self-esteem 3
• Structural collapse can compromise the nasal airway, as the internal nasal valve is responsible for more than two-thirds of airflow resistance, and any disturbance in turbulent airflow pattern is perceived as obstruction 1
• Restoration of pretraumatic form and function remains a challenge even with optimal acute management 5