A 42-Year-Old with Swelling After a Kick to the Face

Differential Diagnosis

• Fracture, anterior nasal spine
• Fracture, frontal nasal spine
• Fracture, nasal bone
• Fracture, nasal septum

Diagnosis

This patient sustained fractures of the anterior nasal spine and nasal bone.

Learnings/What to Look for

• The anterior nasal spine is a bony prominence at the intermaxillary suture located on the inferior edge of the nose at the level of the nostrils
• The anterior nasal spine is a major anatomic landmark for surgery involving the maxillofacial region, dental procedures, and in clinical nasal endoscopic sinus surgery
• Fractures of the anterior nasal spine in maxillofacial trauma are not uncommon (22%). However, the missed diagnosis rate of anterior nasal spine fractures is very high (95.4%) because this structure is often overlooked

Pearls for Urgent Care Management

• Conservative treatment is often sufficient, but open reduction and internal fixation via intraoral incision can be performed for displaced fractures

Acknowledgment: Image and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).