Classification of nasal bone fractures

There is no standardized, worldwide accepted classification for nasal fractures. We provide a simple classification system based on clinical findings.

Laterally displaced fractures occur secondary to a lateral blow to the nose. The nasal bones are pushed medially on the side of the impact and laterally on the contralateral side.

They make up the majority of nasal fractures. Most of them can be managed by closed reduction.

The dorsal part of the nasal septum is usually involved and can be displaced.

Posteriorly depressed fractures occur secondary to a direct blow over the nasal bones, which are pushed inside to the ascending process of the maxilla. The nasal septum is always involved. This type of fracture can be associated with NOE fractures.

A disarticulation of upper lateral cartilage is usually due to a localized strong blow to the central third of the nose, as in car accidents with the steering wheel hitting the nose. The upper lateral cartilage can be avulsed from the bone.

The diagnosis is mostly clinical because cartilage is not visible on standard radiographic imaging. It can be diagnosed on soft-tissue windows of CT scans.

Cartilage injuries are more often suspected than absolutely confirmed.

A nasal spine fracture usually occurs in association with other more extensive nasal or maxillary fractures. Displaced fractures are often associated with nasal septum dislocations or fractures.

The illustration shows an anterior nasal spine fracture which occurs in association with degloving injuries of the upper labial vestibule as in a steering wheel injury.

Moderately displaced anterior nasal spine fractures occurring with septal dislocation should have the spine and septum replaced into a midline position and stabilized to the maxilla.

The nasal septum is almost always involved in nasal fractures and must be evaluated to determine if treatment is necessary. Nasal bone displacement is always accompanied by septal fractures. Significant forces cause significant displacement and comminution of the nasal septum.

Nasal septal injuries often lead to nasal airway compromise. The need for repair is individualized based on the particular anatomy of the fracture and the patient’s symptoms.

Septal injuries may result in a loss of support of the cartilaginous dorsum and columella in the bottom half of the nose and often require repair, splinting, or reconstruction.