What is the treatment for a nasal bone fracture with significant displacement?

From the Guidelines

The treatment for a nasal bone fracture with significant displacement typically involves repositioning of nasal bones through osteotomies, which may include lateral and medial osteotomies, to achieve a symmetrical shape and position of the nasal bones 1.

Key Considerations

• The sequence of osteotomies may be changed to medialise the nasal bones and bony septum, "like opening a book", if nasal dorsal lowering is not performed in case of severe bony deviation 1.
• Limited external deviations may be corrected with a unilateral osteotomy, leaving the opposite bony sidewall in its former position, providing stability in the osteocartilaginous nasal framework 1.
• Additional support by cartilage spreader graft reaching up into the bony vault may be used to prevent recurrent collapse 1.

Surgical Techniques

• Tangential hump removal with asymmetric preservation of the more vertically orientated nasal bone aims to produce a symmetrical shape and position of the nasal bones after osteotomies 1.
• Periosteal tunnels are detrimental to support, which may be unadvantageous, and nasal bone mobilisation is achieved using the smallest possible osteotomies (intranasally and/or percutaneously) 1.
• Sliding low over the nasal facial groove to prevent step off deformities, the osteotomy ends high on the nasal bone at the level of the medial canthus 1.

From the Research

Treatment Options for Nasal Bone Fracture with Significant Displacement

• The treatment for a nasal bone fracture with significant displacement can be performed under various types of anesthesia, including general anesthesia, local anesthesia, and topical anesthesia 2, 3, 4.
• Closed reduction of the fracture under general or local anesthesia with elevators or forceps is widely used to treat nasal bone fractures 3.
• However, operating under general anesthesia increases the risk of morbidity and raises the cost of management, while using forceps or elevators may cause undercorrection, new fractures, mucosal damage, and nasal hemorrhage 3.
• Manual reduction under local anesthesia, using the little finger, can minimize the demerits of treatment under general anesthesia with forceps or elevators and has been shown to have high patient satisfaction and favorable postoperative functional and aesthetic outcomes 3.
• Monitored anesthetic care (MAC) is also a viable option for closed reduction of nasal bone fractures, offering a safer and more efficient alternative to general anesthesia in certain cases 4.
• Ultrasonography-assisted closed reduction under local anesthesia can provide palpation-less confirmation of proper reduction, allowing for nasal bone reduction under local anesthesia 5.
• Endonasal infiltrative anesthesia can be used in conjunction with topical and external transcutaneous infiltrative anesthesia to reduce pain during nasal bone fracture reduction 6.

Anesthesia Considerations

• Topical anesthesia is suggested in simple nasal fracture with unilateral depression or minimal displacement 2.
• Local anesthesia can be used for patients with mild unilateral or bilateral nasal bone fractures, with high patient satisfaction and favorable postoperative functional and aesthetic outcomes 3.
• General anesthesia may be necessary for patients with comminuted nasal bone or septal fractures, or when airway discomfort due to bleeding is expected, or fracture is severe and multiple manipulations are required 3, 4.