Nasal trauma and fractures in children
- Donna Reyes Mendez, MD
Donna Reyes Mendez, MD
- Associate Professor of Emergency Medicine
- University of Texas Health Science Center (UTHSC) Medical School Houston
- Annie Lapointe, MD, MPH
Annie Lapointe, MD, MPH
- Assistant Professor
- University of Montreal, Canada
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Fractures of the facial bones are uncommon occurrences in children younger than five years of age; the incidence increases with increasing age and peaks between 16 and 20 years . One reason for this difference is that young children are relatively protected from the mechanical forces that lead to facial injury . As they age, they participate in activities that increase the risk of exposure to such forces (eg, falls from height, sports, bicycle riding, etc).
The nasal bones and mandible are the facial bones most commonly fractured in children . Nasal fractures occur more commonly than do mandibular fractures because they require less force to produce . Childhood nasal trauma typically results from falls, contact sports, weight lifting, and automobile crashes (usually involving bicyclists or pedestrians) [3,5,6]. Child abuse also must be considered. (See "Physical child abuse: Recognition".)
Most of these injuries are minor. In one retrospective series of 241 children with nasal injury 98 of whom were examined by rhinoscopy, 73 cases involved septal deviation, subluxation, or fracture (30 percent), 13 cases septal hematoma formation (5 percent), and 12 cases subperichondrial abscess (5 percent) .
The upper one-third of the nose is supported by the paired nasal bones and the frontal processes of the maxilla; the lower two-thirds are maintained by cartilaginous structures . The superior portion of the nasal bones is thick and relatively resistant to fracture. In contrast, the inferior portion is thin and weak. The bony nasal septum articulates with the undersurface of the nasal bones to provide support to the nasal dorsum. The lacrimal bones and ethmoid labyrinth lie deep to this bony pyramid .
A paired cartilaginous framework, separated in the midline by attachments to the quadrangular septal cartilage, provides support to the lower two-thirds of the nose. The upper lateral cartilages attach to the undersurface of the nasal bones and support the middle one-third. The lower lateral cartilages consist of medial and lateral crus, which join in the midline to form the tip of the nose and support the lower one-third .
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