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Case 5 - Multiple Fractures in Nasal Bones

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0:01

Let's return to the patient who was

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hit in the face with a bag of bricks,

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was assaulted with a bag of bricks and

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had multiple fractures. So again,

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we're going to focus for the purposes of this segment

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just on the nasal bones.

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So as we come up superiorly,

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we come into the nasal bones and we notice that there are

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fractures involving the nasal bones that are comminuted

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and offset slightly bilaterally. This one a little bit inward,

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this one a little bit outward,

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and you can see that there's multiple pieces of the bone

0:35

even as it comes up to the frontonasal suture.

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I want to just, again,

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point out the importance of making attention,

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pointing attention to the nasal septum

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because as you can see here,

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the patient has a fracture of the nasal septum which is

0:51

displaced, and the fracture fragment is obliquely oriented.

0:57

The nasal septum is actually a three part structure.

1:00

It includes the perpendicular plate of the ethmoid bone,

1:04

which is seen here, and which, as you can see,

1:08

is fractured at its superior portion.

1:11

So this is the perpendicular plate of the ethmoid bone and

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it comes and communicates with the ethmoid sinuses.

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The inferiormost portion is something called the vomer,

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and the vomer is a bony portion of the nasal septum.

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But far anteriorly,

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what we have is the cartilaginous portion of the

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nasal septum. The cartilaginous portion, again, as I mentioned,

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because it's not bony, you can have fractures of the cartilage.

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It's just we don't see it very well on CT scanning

1:42

and it's more of a clinical diagnosis.

1:44

So here we have an example of a patient who has, down here,

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a fracture of the vomer. And more superiorly,

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a fracture of the perpendicular plate of the ethmoid bone.

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Two portions of the nasal septum.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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