Treatment of Anterior Nasal Spine Fractures

Initial Diagnostic Assessment

Obtain CT imaging with three-dimensional reconstruction to confirm the fracture and assess displacement of the anterior nasal spine, as this is the gold standard for characterizing midface injuries 1
Assess for associated septal deviation, as the septum must be repositioned before addressing bony structures, according to the Rhinology guidelines 2, 3

Use permanent 5-0 nylon suture or PDS 4-0 suture driven through soft tissue including periosteum, or through small drill holes in the nasal spine or premaxillary ridge for repositioning, as recommended by Rhinology 2, 3
Recognize that even slight deviations with residual cartilage tension may not be predictably corrected without surgical intervention, according to Rhinology 2, 3

Address any associated septal deviation first, as "as the septum goes, so goes the nose", according to Rhinology 2, 3
For caudal septal deflection accompanying anterior nasal spine fractures, use suture fixation through the nasal spine or premaxillary ridge on the opposite side of deviation, as recommended by Rhinology 2, 3
Consider the "contralateral subluxation locking" technique if the caudal septum is bowed, repositioning at least 1 cm width of septum to the contralateral side of the thinned nasal spine/maxillary crest, according to Rhinology 2, 3

Do not overlook associated septal injuries, which are responsible for postoperative nasal deformity and obstruction if left unaddressed, as noted in Praxis Medical Insights 4