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Nasal-Septal Fracture

Francis B. Quinn, M.D.

Herve’ J. LeBoeuf, M.D.

Nasal fracture is the most common facial fracture, and the third most common fracture of the skeleton overall. However, because many fractures are subclinical and many others are associated with multiple trauma, a high percentage are not diagnosed or treated at the time of injury. These often lead to chronic nasal obstruction and account for many of the septoplasty procedures performed for obstruction and septal deviation. Most facial fractures can be restored to their preoperative state with proper early intervention. The following synopsis is a look at the early diagnosis and treatment of nasal fractures with the goal being the prevention of these late complications.

Anatomy

The external nose is a triangular pyramid composed of cartilaginous and osseous structures that support the skin, musculature, mucosa, nerves, and vascular structures. The upper third of the nose is supported by bone, and the lower two-thirds gains its support from a complicated interrelationship of the upper and lower lateral cartilage’s and the nasal septum. The skin in the upper portion of the nose is freely movable and thin; in the lower portion the skin is thick and has prominent sebaceous glands. In the distal nose the attachment of the skin to the underlying cartilaginous structures is more intimate. The entire nose has an excellent blood supply, which permits extensive dissection with safety and results in early, rapid healing. The supporting framework of the nose is made up of semirigid cartilaginous structures that are attached to the solid and inflexible bone structure of the nose. The cartilaginous tissues include the lateral nasal cartilages, the alar cartilages, and the septal cartilage. There are several sesamoid cartilages in the lateral portions of the ala and in the base of the columella. The cartilaginous structures support the overlying...