NOEandFrontalfractures.doc.docVIP

NASAL FRACTURES most common type of facial fracture and the third most common fracture of the human skeleton weakest bone and in a central and prominent position high incidence of posttraumatic nasal deformity (14 to 50 percent). Factors that contribute to suboptimal aesthetic and functional end results include timing, edema, undetected preexisting nasal deformity, and occult septal deviation/injury. Patients with traumatic septal deviation have a high chance of requiring secondary surgery - 40 to 42 percent had a significant septal deformity at 3 months that required septorhinoplasty. Pathogenesis of nasal fractures A strong force from any direction can comminute the nasal bones, giving rise to the “open book” type of fracture. When fracture of the thick bone at the root of the nose occurs, it is usually associated with fractures of other parts of the facial skeleton Pathogenesis of septal fractures three septal zones with thicker cartilage where it attaches to bone -dorsoposterior, basal, and caudal. central caudal portion of the septum is thin. The thicker, posterior septal cartilage provides the primary support for the nasal dorsum. Low-velocity injuries usually lead to septal fractures or dislocations along the vomerine groove; high-velocity injuries or frontal impacts result in more extensive septal fractures through the thin central region of the quadrangular cartilageprogressive distortion of fractured septal cartilage caused by the release of locked internal stresses septum does not remain straight after manipulation and that the nasal bones tend to unite in the direction of the deviated septum. Acute open reduction with submucous septal resection results in an improved long-term cosmetic and functional outcome due to the alleviation of overlapped, interlocking fragments of the septum that usually resulted in the secondary nasal bone deformity. Thus septum is the key structure with which to align/correct and optimize nasal fracture management and to min