The Anatomy of the Nasal Bone

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The nasal bones are two oblong halves that meet to form the bridge of your nose. The nasofrontal suture, which is a rigid fibrous joint that connects the two halves of the nasal bones, forms the thickest part of the nose.

The nasal bones along with the frontal processes of the maxilla make up one of three nasal vaults, known as the bony vault. Because this area of your nose is the thickest, it is used to support other structures of the nose like your nasal septum.

Anatomy

The nose is one part of your body that does not necessarily follow any standard sizes. While you may physically stop getting taller during your adolescent years, your nose does not stop growing throughout your lifespan. While noses are relatively small compared to other parts of your body, there are many different aspects to them that make up a very distinguishing part of your face.

The upper vault of your nose, or bony vault, is actually the only bony part of your nose. The other two vaults towards the tip of your nose are actually made of cartilage. The nasal bones, along with the frontal processes of the maxilla bone form the bony vault, is the thickest part of your nose.

At the top of the nasal bones, along the nasofrontal sutures, the nasal bones meet the frontal bone of your skull. This point is referred to as the nasion. The rhinion is where the bony vault meets the cartilaginous vault, which is on the opposite side of the nasal bones (towards the tip of your nose). This is the area of your nose that has the thinnest amount of skin on your nose.

The top of the bony vault, which is at the curve of your nose between your eyebrows, is known as the radix. The radix is important, as the angle of this area determines whether your nose appears elongated or shorter.

Function

The bony vault has many important protective functions. The nasal bones form the roof, while the frontal process of the maxilla and lacrimal bone forms the sides of the nose. Where the maxilla and lacrimal bones connect, the lacrimal groove is formed. This groove is where the lacrimal sac resides. The lacrimal sac is important in the tear production process.

The anterior ethmoidal nerve runs underneath the protection of the nasal bones. several arteries also run through the bony vault.

As the hardest part of the nasal cavity, the nasal bones protect these arteries and nerves from damage.

Since the nasal bones are the strongest part of the nose, not only does it house arteries and nerves, but it also supports your nasal septum.

Associated Conditions

The nasal bones are the most frequent facial bones that are fractured in young children. Most injuries are minor and occur related to:

  • Automobile accidents
  • Contact sports
  • Falls (most common in children)
  • Fights (most common in general)
  • Weight-lifting

Approximately 30 out of 100 broken noses result in septal deviation, dislocation or fracture. Children are more common to have broken noses because they have a larger proportion of cartilage in their noses than adults do. Because children's nasal bones have not fused together at the nasofrontal suture line and they have a higher proportion of cartilage, the majority of nasal fractures are greenstick fractures. Excessive bending leads to greenstick fractures (named after fresh wood, which is also called "green" wood, as it easily breaks when bent).

Nasal bone fractures can also occur with other complications because of the nerves and blood supply that is in the area. The nasal bones are also close to other facial structures, so blunt force causing fracturing of nasal bones can also lead to more severe injuries including trauma to your ethmoid bone and your orbital bones. Your ethmoid bone separates your nasal cavity from your brain, while your orbital bones surround your eyes.

Injuries that involve additional facial bones include nasoethmoid and nasoorbitoethmoid fractures. Both of these injuries involve the fracturing of not only nasal bones but also the ethmoid and/or orbital bones. These injuries are very extensive and require timely intervention to reduce the risk of prolonged problems.

Other possible injuries that can occur along with nasal bone fractures include:

Treatment

If you think you have broken your nose, you should contact a doctor or healthcare professional immediately and see him/her in person. However, there are steps you can take in the meantime on your own to help the injury.

Steps to Follow for a Broken Nose

  • Apply ice to your nose.
  • Elevate your head.

Both the application of ice and elevation of the head are used in order to help reduce swelling. Nasal decongestants, such as Afrin, may also help reduce swelling until you are seen by a doctor.

If you sustain a nasal injury, it is best to be examined by a doctor. While imaging studies, such as X-rays and CT scans can be used to help determine a fracture, a physical examination is often the best and most useful piece of the exam. During a physical inspection, your doctor will do the following:

  1. Examine your nose to assess if it has remained straight (if there is a C-shaped appearance, then you likely have a deviated septum)
  2. Examine your nose by feeling (palpating) the different parts of the nose including the nasal bones
  3. Inspect the interior of your nose using a nasal speculum, which is a small clamp looking instrument to open up your nares for easier visualization (if you are seeing an ENT (ear, nose, and throat doctor), they may also use a rhinoscope to visualize inside your nose to look at the mucous membranes, nasal septum, and sinuses
  4. Your doctor still may want some radiographic images (in most instances X-ray images will not provide enough useful information; a CT scan is most helpful in ruling out other facial fractures)

Since the nose is in close proximity to your mouth and neck, your doctor will also look for other signs of complications not related to your nose including:

  1. Neck and spinal cord injury
  2. Vision problems (you may be referred to either a neurologist and/or an optometrist)
  3. Malocclusion of your teeth

If fracturing of the nasal bones and surrounding tissue is minimal and breathing is unaffected, then observation is typically the recommendation. If your nasal bones are more fractured and displaced, the type of procedure used to repair the fracture will be dependent on the severity of the fracture.

Closed Reduction

If nasal bones have been displaced, but fracturing is not severe, local or general anesthesia can be used while your doctor manually sets your nasal bones back into place. No cutting of the skin is required. This procedure is referred to as closed reduction. Repairing fractures with a closed reduction should be performed by either an ENT, a plastic surgeon, or a maxillofacial surgeon for best results.

Open Reduction

Open reduction refers to the surgical procedure where your doctor uses an incision to visualize and repair your nasal bones. In repairing your nasal bones, your doctor may need to use instruments called osteotomes, which look like small chisels, to help reshape your nasal bones to fit back together nicely.

In situations where immediate repair is not warranted, your doctor may choose to let your nose heal on its own and let the swelling diminish before surgery. In this case, you will be scheduled for a septorhinoplasty, or a nose job, where your doctor can surgically repair and reshape your nasal bones, septum, and cartilage of your nose.

If you have displaced nasal bones which require open reduction or closed reduction, you will likely have some amount of deformity to your nose. In this case, you may also want to have a septorhinoplasty as a follow-up procedure to repair your deviated septum.

Following any repair of broken nasal bones, surgically or manually manipulated, you need to allow your nose several weeks to heal. Since the nasal bones are still mobile for approximately two weeks after repair, it is recommended to refrain from all sports for two weeks. Despite being healed sufficiently for most activities in two weeks, the nasal bones can still be forcibly separated up to six weeks after repair.

It is recommended that you refrain from contact sports for this six-week period. Most athletes return to their sport (both non-contact and contact sports) following a nasal bone fracture.

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Article Sources
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  • Nasal Fracture. Medscape. Updated on December 06, 2018.

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