Management of Nasal Fractures

Diagnostic Approach

The American College of Radiology recommends CT imaging as the preferred diagnostic modality for nasal fractures, offering superior detection and characterization compared to conventional radiography, especially for complex injuries with associated facial fractures 1, 2
Conventional nasal radiographs have limited diagnostic value with accuracy ranging only from 53% to 82% and do not significantly alter diagnosis or management of nasal fractures 1, 2
Ultrasound may be considered as an alternative with high accuracy (sensitivity 90-100%, specificity 98-100%) particularly for isolated nasal bone fractures and can better detect nondepressed fractures of the nasal bridge and anterior septal cartilage deviation than CT 2, 3

Assess for associated injuries including other facial fractures and intracranial injuries, as recommended by the American College of Radiology 1, 4
Determine the presence and degree of septal deviation, as septal correction must precede nasal bone realignment, according to Praxis Medical Insights 5

Position the septum into the midline using a transverse root osteotomy, as suggested by Praxis Medical Insights 5
Place a strut between the medial crura for support and realignment, according to Praxis Medical Insights 5

Consider camouflaging techniques, such as dorsal onlay grafts using septal cartilage, to hide residual deviations, as recommended by Rhinology and Praxis Medical Insights 5, 6

Short nasal bones are a relative contraindication for osteotomies, as they risk bony communication while yielding limited results, according to Praxis Medical Insights 5
Associated septal injuries can be responsible for postoperative nasal deformity and obstruction, requiring additional correction, as suggested by Praxis Medical Insights 7

The American College of Radiology recommends screening for other facial fractures, intracranial injuries, and cervical arterial injuries using the clinical context in patients with nasal fractures 8

The Rhinology society recommends preserving periosteal and mucosal attachments of the nasal bone to minimize destabilization of the osseous framework during nasal bone reduction 9
The Rhinology society suggests using the smallest manipulative force necessary to achieve reduction and avoiding creating periosteal tunnels, as these are detrimental to support 9
The Rhinology society recommends performing osteotomies while preserving periosteal and mucosal attachments, and using the smallest possible osteotomies for mobilization 9
The Rhinology society advises considering camouflaging techniques such as dorsal onlay grafts using septal cartilage to hide residual deviations when complete correction is impossible 9

The Rhinology society notes that short nasal bones are a relative contraindication for osteotomies, as they risk bony communication while yielding limited results 9
The Rhinology society warns against intermediate osteotomies, as they risk visible irregularities or step-off deformities in areas with thin overlying skin 9