Case 5 - Nasal Bone Fracture Summary
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As you've seen by some of my examples,
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nasal bone fractures don't often occur in isolation.
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They often have associated fractures.
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Here's an example of a patient who has multiple,
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"nasal bone fractures", as well as other
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fractures. So if we look in the first image,
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we see that the anterior nasal or maxillary
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spine here has been fractured.
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This is a fracture that is very easily demonstrated on sagittal
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reconstructions as long as you do them with thin enough
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sections. If it's too wide a section, unfortunately,
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you may get partial volume averaging
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and you may not see the fracture.
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But this little spine here is referred to as the anterior
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nasal spine or the anterior maxillary
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spine or the maxillary spine.
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And this is, again, part of that complex
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of a nasal bone fracture,
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even though it really doesn't involve
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the nasal bones themselves.
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Here you have a fracture that do involve the nasal bones,
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not only of the nasal bones, but also
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of that suture that I mentioned previously.
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This little asterisk here,
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which is demonstrating the nasomaxillary suture,
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which is this structure, which is coming down right along here.
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That's to be separated from the frontomaxillary suture, which we
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will see in just a moment as part of the naso-orbito-ethmoidal
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complex. So, fractures of the nasal bone as well
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as the nasomaxillary suture. And here's,
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the nasal bone fracture on the sagittal.
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In addition,
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you notice that this patient's anterior portion
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of the maxillary antrum has been fractured.
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But this anterior portion of the maxillary antrum is the common
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wall with the orbital rim, as well as more posteriorly,
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the orbital floor affecting the infraorbital nerve.
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This fracture extends to involve the nasolacrimal duct.
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So, what you're seeing
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are these little areas right here and right here.
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So let me remove the... and you can see the wall of the normal
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nasolacrimal duct has been fractured
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with a free fragment right here.
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So that's the nasolacrimal duct fracture. A portion, again,
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that we will talk to in just a moment about the naso-orbito
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ethmoidal complex. And in addition,
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the medial maxillary wall has been violated.
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So multiple fractures, not just including the nasal bones.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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