What are the complications of nasal bone fractures?

Complications of Nasal Bone Fractures

Nasal bone fractures commonly result in postoperative deformity (11.2%), nasal obstruction (6.1%), and associated septal injuries (96.2% of cases), with more severe fractures carrying higher complication rates. 1, 2

Immediate/Early Complications

Septal Hematoma

• Requires urgent ENT drainage to prevent septal necrosis and subsequent saddle nose deformity 3
• Occurs in approximately 5% of nasal bone fractures 4
• Represents a surgical emergency that can lead to permanent cartilage destruction if untreated 3

Epistaxis

• Common immediate complication requiring anterior nasal packing or oxymetazoline spray 3
• Persistent bleeding despite conservative measures necessitates urgent ENT referral 3

Associated Facial Fractures

• Orbit fractures are the most common associated injury, occurring in 24.6% of nasal bone fracture patients 1
• Complex midface injuries (naso-orbital-ethmoid, Le Fort, zygomaticomaxillary complex) require immediate maxillofacial surgery referral due to risk of severe functional and cosmetic complications 3, 5
• Approximately 68% of maxillofacial trauma patients have associated intracranial injuries requiring screening 3, 6

Open Fractures

• Occur in 22% of nasal bone fractures 4
• Exposed cartilage requires urgent ENT referral and prophylactic antibiotics to prevent infection 6, 4

Late/Delayed Complications

Postoperative Nasal Deformity

• Occurs in 11.2% of patients after closed reduction 1
• Septal injuries are the primary cause of postoperative deformity and must be addressed during initial treatment 7, 8
• 96.2% of simple nasal bone fractures involve septal fractures, with 78.8% requiring septoplasty or submucosal resection 2
• More severe nasal bone fractures have significantly higher rates of postoperative deformity 1

Nasal Obstruction

• Occurs in 6.1% of patients postoperatively 1
• Results from untreated septal deviation, mucosal edema, or inadequate initial reduction 7, 6
• Septal correction must precede nasal bone realignment when septal deviation is present to prevent this complication 3, 6

Olfactory Disturbances

• Occurs in 1.1% of patients 1
• Can result from cribriform plate involvement or severe nasal trauma 1

Critical Diagnostic Pitfalls

Unrecognized Septal Fractures

• Physical examination finding of mucosal tearing is statistically significant for septal fracture 2
• CT imaging helps diagnose septal fractures but cannot accurately predict severity (only 33.5% correlation between CT grading and operative findings) 2
• Direct visualization via hemitransfixion incision is necessary to assess true severity and determine need for septoplasty 2

Cerebrospinal Fluid Leak

• Suggests cribriform plate involvement and requires urgent neurosurgical consultation 3, 6
• Must be actively screened for in all nasal bone fractures with clear rhinorrhea 3

Risk Factors for Complications

• Severity of initial fracture directly correlates with complication rates 1
• Delayed treatment beyond 2 weeks increases risk of inadequate reduction and secondary deformities 1
• Unrecognized or untreated septal injuries are responsible for the majority of postoperative deformities and obstructions 7, 2
• Associated complex midface fractures (naso-orbital-ethmoid) can result in telecanthus, enophthalmos, lacrimal obstruction, and ptosis if not managed by subspecialists 6, 5