Nasal Septal Fracture

Excerpt

The nasal bones are the most frequently fractured bones in the maxillofacial area due to their relative weakness and the outward projection of the nose on the face. Nasal septal fractures have been associated with nasal bone fractures in 42% to 96% of cases. Nasal bone and septal fractures have an impact not only on cosmetic appearance but also on nasal airway function as well.

The structural support of the nose is composed mainly of cartilage, bone, and skin. The paired nasal bones are attached to the frontal bone superiorly and the frontal processes of the maxillae laterally, at the nasofrontal and nasomaxillary suture lines, respectively. The nasal bones tend to be thicker above the level of the medial canthus.

The nasal septum consists of bone posteriorly and cartilage anteriorly. The perpendicular plate of the ethmoid bone superiorly and the vomer inferiorly make up the bony septum. These fuse with the quadrangular cartilage, which makes up the anterior portion of the nasal septum. The quadrangular cartilage provides support for the nasal dorsum from the keystone area to the supratip of the nose. This keystone area is a major structural support of the middle one-third of the nose, constituting the 10-15 mm of bony-cartilaginous septal junction immediately inferior to the rhinion. At the level of the keystone, the upper lateral cartilages articulate with the caudal edges of the nasal bones; the upper lateral cartilages are also attached to the dorsal margin of the cartilaginous septum, which is firmly adherent to the perpendicular plate of the ethmoid bone. The septum is attached to the nasal floor anteriorly at the nasal spine and posteriorly at the nasal crest of the maxilla and palatine bones.