Module 5 - Head and Neck
Craniomaxillofacial Trauma
Nasal Fractures
Four Types:
- Lateral blow
- Plane 1 - Anterior portion of nasal pyramid and septum
- Plane 2 - Communication and extensive dislocation of septum and nasal pyramid
- Plane 3 (NOE) - Involve the frontal processes of the maxilla
Treatment of Nasal fractures
- Assessment includes observation, palpation, intranasal examination, cold packs
- Speculum exam to rule out septal hematoma, mucosal lacerations
Lateral Blow Injury
- Fractures present with swelling, epistaxis, lacerations, pain, respiratory obstruction
- Most common facial fracture
- Classical history and physical appearance
- Immediate lateral pressure can reduce fracture (before swelling interferes with symmetry); often performed by an experienced sports trainer
- Reduction in the emergency room shortly after injury
- Presentation delayed, refer to plastic surgeon at 5-8 days post injury
Plane 1, 2 and 3 fractures
- Involves reduction of nasal pyramid and nasal septum
- Bones are first "out"-fractured & then reduced
- Open reduction is required in plane 2 and plane 3 fractures
- Fractures in this group require referral for treatment
Post Reduction
- Plaster cast or pre-fabricated splint should be applied for 7-10 days
- Anterior nasal packing for 24-48 hrs
- Residual deformity if present is treated after 6 months by corrective septorhinoplasty
Author: Dr. R. Bendor-Samuel