0:01

Let's return to the patient who was

0:03

hit in the face with a bag of bricks,

0:06

was assaulted with a bag of bricks and

0:08

had multiple fractures. So again,

0:10

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

0:13

just on the nasal bones.

0:15

So as we come up superiorly,

0:17

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

0:20

fractures involving the nasal bones that are comminuted

0:25

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

0:28

this one a little bit outward,

0:30

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

0:35

even as it comes up to the frontonasal suture.

0:38

I want to just, again,

0:40

point out the importance of making attention,

0:44

pointing attention to the nasal septum

0:46

because as you can see here,

0:47

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

1:14

it comes and communicates with the ethmoid sinuses.

1:18

The inferiormost portion is something called the vomer,

1:22

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

1:27

But far anteriorly,

1:29

what we have is the cartilaginous portion of the

1:32

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

1:35

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

1:39

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,

1:49

a fracture of the vomer. And more superiorly,

1:52

a fracture of the perpendicular plate of the ethmoid bone.

1:56

Two portions of the nasal septum.

Case 5 - Multiple Fractures in Nasal Bones

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