Department of Otorhinolaryngology Head and Neck Surgery

Faculty of Medicine - Andalas University

Dr. M. Djamil Hospital, Padang 2014

Nasal & Naso-Orbital-Ethmoid Fracture

Chandra - Nur
Facial Plastic and Reconstructive Surgery SubDivision
 Nasal Fractures
• Nasal bone fracture are the most commonly
fracture of all facial bone
• Male > female
• The goal of nasal fracture management should
be to reestablish the preexisting nasal airway
and cosmetic

Facial Plastic & Reconstruction Surgery SubDivision

Nasal Fractures
Nasal Fractures
 Nasal Fractures
 Symptoms
 Epistaxis
 Rhinorrhea
 Nasal obstruction
 Detailed history exploring mechanism & timing of
injury, and loss of consciousness help
distinguish isolated nasal and septal fractures
from other injuries.

Bailey B.J, Johnson J.T, Head and Neck Surgery,

Otolaryngology, Maxillary and Periorbital fracture, 2006
Facial Plastic & Reconstruction Surgery SubDivision
 Nasal Fractures
• Sign
 Depression or displacement of nasal bones
 Edema of nose generally limited within the first 2 to 3
hours after the trauma
 Crepitus and tenderness on palpation
 Fracture of septal cartilage with displacement or mobility
 Septal hematoma
• Detailed facial examination also important & should include
visual acuity, extraocular muscle movement, pupil size and
reactivity, intercanthal distance, medial canthal tendon
position, mandibular range of motion, and occlusion

Facial Plastic & Reconstruction Surgery SubDivision

 Nasal Fractures
All nasal injuries should be
evaluated for septal
hematoma

Untreated abscess, necrosis septal

and saddle nose deformity

Bailey B.J, Johnson J.T, Head and Neck Surgery,

Otolaryngology, Maxillary and Periorbital fracture, 2006
Facial Plastic & Reconstruction Surgery SubDivision
 Nasal Fractures
• Radiographs:
– Lateral projection
• Treatment:
– Surgical

Bailey B.J, Johnson J.T, Head and Neck Surgery,

Otolaryngology, Maxillary and Periorbital fracture, 2006
Facial Plastic & Reconstruction Surgery SubDivision
Nasal Fractures

Facial Plastic & Reconstruction Surgery SubDivision

 NOE
• Houses the lacrimal apparatus, medial canthal
ligament, and anterior ethmoidal artery
• Assessment of these injuries requires close
attention to the soft tissue and osseous
structures and an accompanying CT
scan(coronal and axial views)

Facial Plastic & Reconstruction Surgery SubDivision

 NOE
• Frontomaxillary buttress provides structural
support to this region and serves stabilization
point for reconstruction
• Lateral buttresses are frontal bar superiorly
and the zygoma and inferior orbital rims
inferiorly
• Medial portion of the buttress contains the
perpendicular plate, lacrimal ones, and lamina
papyracea

Facial Plastic & Reconstruction Surgery SubDivision

 NOE
• Symptom
– CSF rhinorrhea
– Epistaxist
• Sign
– Telecanthus (>45mm)
– Diplopia
– Epiphora
– Narrowing of the palpebral fissure
– Periorbital edema
– Flatting of the base of the naso-
orbital valley
 NOE type 1(Markowitz)
• Only one portion of the medial
orbital rim, with its attached medial
canthal tendon
• May uni / bilateral
• Management:
• 3 point rigid fixation
reestablishing the relationships of
the nasofrontal junction to the nasal
complex, the nasal complex to the
maxillary buttress, and the nasal
complex to the infraorbital rim
Oral & maxillofacial trauma
 NOE type 2
• May uni / bilateral
• Large segment /
comminuted and
canthus medial
attached to large
central segment
• Require extensive
superioinferior
approach  coronal
flap and infraorbital and
intraoral inscision
Oral & maxillofacial trauma
 NOE type 3
• Comminution involving
the central fragment of
bone where the medial
canthal tendon attach
• Require trannasal wiring

Oral & maxillofacial trauma

 NOE
• Coronal incision is most
used in management of
fracture on the NOE
region
• A lower eyelid incision
may also necessary to
gain access to the
inferomedial orbital
component
Thank You

Facial Plastic & Reconstruction Surgery SubDivision