Case 05 2026: Partial avulsion of the nasal tip

Nicolai Lassen Frid; Johan Hindkjær Therchilsen; Jakob Gerlach Christensen

Journal of Plastic, Breast & Reconstructive Surgery·Rapports de cas chirurgicaux en libre accès, évalués par les pairsÉvalué par les pairs · Libre accès

Case 05 2026: Partial avulsion of the nasal tip · JPBRS

Rapport de cas

Case 05 2026: Partial avulsion of the nasal tip

Nicolai Lassen Frid¹, Johan Hindkjær Therchilsen¹, Jakob Gerlach Christensen¹

¹Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark

Publié 28 mai 2026228 vues5 min de lecture

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Résumé

Traumatic partial avulsion of the nasal tip is a rare condition that can present both functional and aesthetic challenges. This case reports a 58-year-old woman with a partial nasal tip avulsion after a fall onto a metal crate. Examination revealed injury to the lower lateral cartilages with loose cartilaginous fragments. Surgical repair focused on restoration of the structural tip support, using end-to-end sutures for approximation of the cartilage and interdomal suturing. This case focuses on rhinoplasty-based principles in acute management of nasal trauma to preserve projection, symmetry, and long-term stability of the nose. Patient medical history A 58-year-old woman presented to the emergency department with a traumatic partial avulsion of the nasal tip sustained after slipping on ice and striking her face against a metal crate. The patient reported neck soreness but exhibited no signs of concussion and no other facial injuries or neck injuries. She had no prior history of nasal trauma. Her medical history included well-controlled hypertension and chronic back pain. Before and After Patient examination Examination of the external nose revealed a large laceration involving the nasal tip, with partial avulsion on the right side. The lower lateral cartilages were injured, with transection of the right lateral crus, a loose fragment of the right intermediate crus, and bilateral fractures of the medial crura with loose cartilaginous fragments. The skin was intact over the columellar and the left alar surface. The wound edges were well defined and with no tissue loss. Sensation was absent in the lacerated tip, but with preserved capillary refill. Anterior rhinoscopy showed a midline septum without h

Points clés à retenir

Conseils pratiques

-tAccurate realignment of the medial crura is essential to maintain tip support(3).
-tInterdomal suturing helps restore tip projection, contour, and symmetry(4).
-tPreserve cartilage length whenever possible.
-tLayered closure is critical for structural stability.

Écueils

-tFailure to adapt the medial crus fractures may lead to long-term tip deformity and instability(5).
-tInadequate cartilage alignment can result in alar retraction, asymmetry, and nasal stenosis(5).
-tInfection risk must be considered in injuries occurring within the facial ‘danger triangle’.

Patient history

A 58-year-old woman presented to the emergency department with a traumatic partial avulsion of the nasal tip sustained after slipping on ice and striking her face against a metal crate. The patient reported neck soreness but exhibited no signs of concussion and no other facial injuries or neck injuries. She had no prior history of nasal trauma. Her medical history included well-controlled hypertension and chronic back pain.

Examination

Examination of the external nose revealed a large laceration involving the nasal tip, with partial avulsion on the right side. The lower lateral cartilages were injured, with transection of the right lateral crus, a loose fragment of the right intermediate crus, and bilateral fractures of the medial crura with loose cartilaginous fragments. The skin was intact over the columellar and the left alar surface. The wound edges were well defined and with no tissue loss. Sensation was absent in the lacerated tip, but with preserved capillary refill.
Anterior rhinoscopy showed a midline septum without hematoma or mucosal injury. There were no epistaxis and no fractures of the nasal bones. Sensation in all three branches of the trigeminal nerve was intact. A minor mucosal laceration in the midline of the lower lip and a fissure of the upper lip, without dental injury or malocclusion.
Due to the extent of the laceration and the cartilaginous injury, surgical repair under general anaesthesia was indicated.

Pre-operative considerations

The nasal tip is supported by three major support mechanisms: The ligamentous attachments from the medial crura of the lower lateral cartilages to the caudal portion of the septum, the inherent strength of the lower lateral cartilages, and the interdigitation of upper and lower lateral cartilages at scroll region(1-2). In this case, the disruption of the medial crura directly compromised:
-tTip projection
-tColumellar support
-tDome symmetry
-tInterdomal relationship
Failure to restore these structures risks:
-tLoss of projection
-tDroopy tip
-tAlar retraction
-tLong-term asymmetry
Given preserved vascularity and absence of tissue loss, a primary structural repair was indicated.

Étape 1 — Exposure of the cartilage

After induction of general aesthesia, infiltration with local anaesthetic with adrenalin was administered in the nasal mucosa to reduce bleeding and facilitate dissection.
The lower lateral cartilages were partially exposed bilaterally through the existing laceration. Devitalized tissue was conservatively debrided to preserve vascular supply.

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Case 05 2026: Partial avulsion of the nasal tip

Résumé

Points clés à retenir

Patient history

Examination

Pre-operative considerations

Étape 1 — Exposure of the cartilage

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Étape 2 — Cartilage reconstruction

Étape 3 — Restoration of tip definition

Étape 4 — Skin and mucosa closure

Étape 5

Post-operative plan

Pearls

Pitfalls