The pitch is a battlefield, and player injuries are commonplace. During the Belgian First Division match between Standard Liège and Genk, home team player Casella Gonzalez was violently kicked in the head during a challenge. Play was immediately halted, and Casella was rushed to the hospital.Subsequent medical diagnosis revealed Casella suffered a mild concussion along with fractures to his cheekbone, nasal bridge, and right eye socket. Reconstructive surgery was necessary to repair and reshape his facial structure.

During football clashes, the nasal bone—being the most prominent facial structure—is particularly vulnerable to injury. Minor incidents may result in bruising and swelling, while severe cases can lead to comminuted fractures.The nasal bone and ethmoid bone are closely connected, so nasal fractures often involve ethmoid bone fractures. After a nasal-ethmoid fracture, the bony framework collapses, causing the nasal root and bridge to collapse. This shortens the nose's height and causes the tip to tilt upward, creating a "pig nose" deformity that significantly alters the patient's appearance. Without timely and effective treatment in the early stages, reconstruction later becomes extremely difficult.Additionally, nasal-ethmoid fractures often damage the attachment of the inner canthus, causing soft tissue deformities around the eye, displacement of the inner canthus, bilateral asymmetry, and widening of the distance between the inner canthi. Simultaneously, some patients may sustain damage to the nasolacrimal duct, leading to epiphora (excessive tearing), dacryocystitis (inflammation of the lacrimal sac), and dacryocystitis with pus accumulation.
The optimal timing for nasal bone repair surgery is generally considered to be either before post-traumatic edema develops (3-6 hours post-injury) or after partial resolution of edema (3-10 or 14 days). This is because tissue edema not only obscures fracture displacement but also impedes proper reduction. However, urgent situations such as localized hematoma, open wounds, or extensive facial fractures require immediate intervention.
The primary surgical objectives are to restore nasal length and septal alignment.A "bird-wing" incision in the nasal vestibule is typically employed. After adequate exposure of the septal cartilage, the displaced septal cartilage must be repositioned within the sphenoid sinus groove and sutured for fixation. Severe septal fractures may require septoplasty or submucosal resection to achieve optimal reduction. If significant nasal dorsum collapse persists despite reduction, simultaneous dorsum reconstruction may be indicated.Autologous bone grafts, such as the cranial external table or iliac crest, are typically used as reconstructive scaffolds. We generally favor the cranial external table for its strength and natural curvature. Two to three layers of cranial external table grafts are stacked as needed to achieve the desired height. The scaffold is then secured to the nasal process of the frontal bone at the nasal root using micro-titanium plates.