Nasal Fracture During Maxillary Expansion-A Rare Complication?

Background and Clinical Significance: This case report describes an unusual complication in an 8-year-old female patient undergoing ME (maxillary expansion) with a tooth-supported maxillary expander with the hyrax screw. Case presentation: After the 36th screw turn in the 5th week of treatment, the patient reported pressure and pain symptoms and the patient's parents observed a bone elevation at the bridge of the nose. The patient was referred to for clinical examination which revealed a bilateral infraorbital hematoma and a movable, and highly sensitive, nasal area upon palpation. A cone-beam computed tomography (CBCT) scan confirmed a displaced nasal bone fracture. Conservative treatment was immediately initiated by reversing the hyrax screw four times, followed by ten additional turns over the next 7 days for a total of 14 back-turns. This procedure led to an immediate improvement in symptoms. An 8-week follow-up CBCT confirmed the physiological repositioning of the nasal bones and healing of the fracture. Conclusions: Although nasal bone fracture is a rare complication of ME, particularly in children, clinicians should be aware of this potential risk and remain vigilant for symptoms of high pressure and pain in the orbito-nasal area. If a nasal fracture is suspected during orthodontic treatment, the orthodontist should immediately cease screw activation. In selected cases, careful reversal of the screw, as described in this report, may be considered as a conservative treatment.