Medial canthal open nasal fracture repair

Open repair of facial fractures may offer better outcomes than closed approaches. Advantages are inherent with direct visualization and the use of fixation devices. Yet, closed approaches are commonly favored for nasal fractures for simplicity, the avoidance of a facial scar, and because exposure to the nasal bones through traditional approaches is limited. Inadequate nasal repair, however, may result in collapsed or crooked noses caused by failure to adequately reduce and fixate fractures. We describe a medial canthal approach that provides optimal bony nasal exposure, minimizes facial incisions, and provides excellent open reduction and direct fixation of nasal fractures.

We retrospectively reviewed 21 consecutive patients with nasal bony fractures surgically treated with open reduction and internal fixation, using a small, medial canthus incision. The surgical technique is described in detail.

In all 21 patients, the entire fractured nasal bridge was visualized. The fractures were reduced and then fixated to the normal anatomic position using a microfixation system (1.0 mm module). The scars were well hidden and tolerated by all patients. At follow-up of 6 to 18 months, 1 patient underwent scar revision for a depressed scar. Another patient required hardware removal secondary to tenderness associated with the microplate. Otherwise, there were no complications such as saddle nose, canthal dystopia, canthal webbing, or nasolacrimal outflow obstruction. No patient needed or desired revision rhinoplasty.

The medial canthal approach was effective in permitting wide exposure and microplate fixation of nasal fractures.