The vertical and horizontal fracture of the nasal septum is ___________.

Explanation

## Correct Answer: A. Chevallet and Jarjaway fracture The **Chevallet and Jarjaway fracture** is the eponymous term for a specific pattern of nasal septal fracture characterized by simultaneous vertical and horizontal fracture lines. This fracture pattern results from blunt force trauma to the nasal dorsum and involves a vertical fracture through the perpendicular plate of the ethmoid bone combined with a horizontal fracture across the vomer. The vertical component typically runs through the midline of the nasal septum, while the horizontal component creates a step-like deformity. This fracture is clinically significant because it can lead to severe septal deviation, airway obstruction, and cosmetic deformity if not properly reduced. In Indian ENT practice, recognition of this fracture pattern is important during the acute management of nasal trauma, particularly in road traffic accidents and interpersonal violence—common causes of facial trauma in India. The fracture may be associated with cerebrospinal fluid (CSF) rhinorrhea if the cribriform plate is involved, requiring urgent neurosurgical consultation. Proper anatomical reduction within 7–10 days of injury is essential to prevent long-term complications including chronic nasal obstruction and saddle nose deformity. ## Why the other options are wrong **B. Citelli fracture** — Citelli fracture is a specific fracture of the **orbital floor** (blowout fracture) that occurs due to blunt trauma to the orbit, not the nasal septum. It involves the maxilla and orbital structures, presenting with enophthalmos and infraorbital nerve paresthesia. This is a common NBE trap because both are nasal/facial fractures, but Citelli is orbital, not septal. **C. Tripod fracture** — Tripod fracture (also called **zygomatic fracture**) involves fractures at three points: the zygomatic arch, the orbital rim, and the maxillary sinus wall. It is a midface fracture pattern affecting the zygomatic bone, not the nasal septum. Students confuse this because tripod is a common facial fracture, but it does not describe septal fracture anatomy. **D. None of the above** — This is a distractor option that tests whether students confidently recognize the Chevallet and Jarjaway fracture as a legitimate, named fracture pattern. Selecting 'None of the above' would be incorrect because the Chevallet and Jarjaway fracture is a well-established eponymous fracture in ENT literature and is the correct answer. ## High-Yield Facts - **Chevallet and Jarjaway fracture** = vertical + horizontal septal fracture (perpendicular plate of ethmoid + vomer) - **Citelli fracture** = orbital floor (blowout) fracture, not septal - **Tripod fracture** = zygomatic fracture at three points (arch, orbital rim, maxillary sinus), not septal - Nasal septal fractures require reduction within **7–10 days** to prevent permanent deformity and airway obstruction - Vertical septal fractures through the perpendicular plate can cause **CSF rhinorrhea** if cribriform plate involved—requires neurosurgical evaluation ## Mnemonics **Facial Fracture Eponyms (CFT)** **C**itelli = orbital floor; **T**ripod = zygomatic; **C**hevallet-**J**arjaway = septal (vertical + horizontal). Use when differentiating named facial fractures on imaging or clinical exam. **Septal Fracture Pattern** **V**ertical (perpendicular plate) + **H**orizontal (vomer) = **VH** = **V**ery **H**igh risk of deformity. Mnemonic for remembering the two-component fracture pattern of Chevallet-Jarjaway. ## NBE Trap NBE pairs Chevallet-Jarjaway with other eponymous facial fractures (Citelli, Tripod) to test whether students can distinguish septal fractures from orbital and zygomatic fractures. The trap is that all three are named fractures of the midface, but only Chevallet-Jarjaway specifically describes the nasal septum. ## Clinical Pearl In Indian emergency departments, nasal septal fractures from road traffic accidents are frequently missed on initial assessment because clinicians focus on more obvious injuries. A high-impact blow to the nasal dorsum should always prompt septal examination and imaging to rule out Chevallet-Jarjaway fracture, as delayed reduction (>10 days) results in permanent cosmetic and functional morbidity that is difficult to correct surgically. _Reference: Bailey & Love's Short Practice of Surgery (Nasal Trauma section); Robbins & Cotran Pathologic Basis of Disease (Nasal Cavity and Paranasal Sinuses)_