Nasofacial trauma is on the increase in China, the main reason may be related to the gradual entry of our country into the automobile society and the increase in the number of car accidents, other causes include violent disputes, industrial accidents, other accidental injuries, etc. Severe nasal and facial trauma not only affects facial appearance or even injures important organs such as the skull and eyes, which can have a significant impact on the quality of life later or endanger life. In this paper, we review and summarize 97 cases of nasofacial trauma patients admitted to the emergency department between January 2007 and February 2010, and achieve better results, as reported below. 1. Data and methods (1) General data: A total of 97 cases of nasofacial trauma, 71 males and 26 females, were treated in the emergency department from January 2007 to February 2010. There were 26 female cases, including 18 cases with nasal and maxillary fractures, 15 cases with nasal penetration injuries, 3 cases with nasal septal penetration injuries, and 7 cases with tissue defects. The age ranged from 4 to 79 years old, with an average of 39 years old. (2) Treatment method Debridement: Gently scrub the wound with 0.25% chloramphenicol wet gauze, clean the wound edge, fully expose the wound, judge the injury, observe whether there is tissue defect, and whether there is obvious active bleeding in the wound edge, the wound is large, and the wound covered with a large amount of blood clot needs to be aspirated with the aid of a suction device to aspirate the blood clot, and immediately stop the bleeding with vascular clamp if there is obvious bleeding. Anesthesia: Observe the trauma and initially conceive a repair plan. If a longer operation time is required, if the trauma is severe or if there are more traumas where local anesthesia may be overloaded with anesthetic drugs, tracheal intubation anesthesia is recommended. If general anesthesia is not needed, at this time, a trauma lisuca spray (7% lidocaine) is given to spray the trauma, while local infiltration anesthesia or nerve block anesthesia is done around the trauma. After anesthesia, the wound is cleaned with saline and hydrogen peroxide alternately, and the skin of the surgical area is disinfected with benzalkonium bromide tincture. Surgical method: If the incision is small or there is no tissue defect, it can be directly sutured in place. If there is a contusion of the dermis, the skin is missing in pieces, and the subcutaneous tissue is not defective can be packed and compressed after free skin grafting. If there is skin with subcutaneous tissue defect, and it is impossible to pull together the sutures or pulling together the sutures will seriously affect the appearance, then flap repair surgery is needed. The nasal bone should be explored during the operation, and if a fracture is found, it should be repositioned and fixed as soon as possible. In five cases, the nasal cavity was dilated with silicone tubes for 6 months after surgery. 2. Results: All patients had one stage of wound healing and satisfactory nasal and facial morphology, one patient had septum correction in stage II, one case was found to have large septum penetration during surgery and septal perforation still occurred after repair, other patients had good nasal function. Typical case: The patient was 15 years old and was transferred to our emergency room 12 hours after the trauma of the car accident. examination revealed irregular laceration of the nasal root, exposure of the nasal bone to see fracture, distorted and swollen nasal bridge, outward displacement of the inner canthus of the right eye, rupture of the lacrimal sac, rupture of the nasolacrimal duct, and diplopia. CT examination revealed bilateral nasal bones, frontal prominence of the right maxilla, fracture of the right septal sinus, and outward displacement of the attachment bone of the inner canthus. He was admitted to the operating room in an emergency and operated with the ophthalmologist under local anesthesia for debridement and revision. During the operation, the ruptured tear sac was firstly cleared, and a nasal tear sac anastomosis was made between the ruptured tear sac and the nasal cavity, and the upper and lower tear dots were fixed in the nasal cavity through the anastomosis with built-in silicone tubes. The collapsed nasal bone was repositioned by elevating it with a repositioner, and the outwardly displaced medial canthus and attached bones were fixed with titanium plates and titanium nails by pulling them inward, and then the partially avulsed medial canthal ligament was fixed on the titanium plates with nylon thread, and after checking that the medial canthus was correctly positioned and the nasal bone had been repositioned, the wound was closed layer by layer, the bilateral nasal cavity was filled with expansion sponge, and the external nose was fixed with aluminum plastic plate nasal clips. One week after the operation, the CT showed that the inner canthus attachment bone was fixed, the appearance of the nose was symmetrical, the nasal bridge was not deviated, the nasal cavity was unobstructed, the right and left inner canthus were symmetrical, there was no diplopia in the right eye, and there was no tear overflow. 3. Discussion For patients with large trauma and active hemorrhage, it is recommended to use intubation anesthesia, which can avoid choking of blood or fluid from flushing the wound into the airway and ensure surgical safety, and also avoid the risk of using too much local anesthetic. If general anesthesia is not needed, a trauma lisproca spray (7% lidocaine) is given at this time to spray the wound, along with local infiltration anesthesia or nerve block anesthesia around the wound. Good anesthesia is a prerequisite and basis for clean debridement, and the painless state facilitates careful debridement by the surgeon and reduces the possibility of foreign body residue in the operative cavity or postoperative infection. After anesthesia, the wound is cleaned with saline and hydrogen peroxide alternately, and the skin disinfection of the surgical area is done with benzalkonium bromide tincture. When clearing the wound, attention is paid to the protection of the patient’s eyes, and the eyes can be closed with a patch to avoid the adverse stimulation of the disinfectant solution on the cornea. The nasal face is located in the center of the face, and the local scar has a greater impact on the facial appearance. When suturing, attention should be paid to the use of different suturing methods and techniques. If the wound is small or there is no tissue defect, it can be sutured directly in alignment. If there is a contusion of the dermis and the skin is missing in pieces, but there is no defect in the subcutaneous tissue, the skin can be packed and compressed after free implantation. Do not use excessive electrocoagulation to stop bleeding on the wound surface of the implant, as large area electrocoagulation will have an effect on the survival of the implant. If there is skin with subcutaneous tissue defect, which cannot be pulled together and sutured or pulled together and sutured will seriously affect the appearance, such as pulling out of the lower lid, upturning of the nose, crooked corners of the mouth, etc., it is necessary to do flap repair surgery, and there are many kinds of flap designs depending on the methods, but attention should be paid to the impact on the appearance of the nose and face, making it consistent with the skin pattern as much as possible, consistent with the direction of local blood vessels, and absolutely tension-free suture. When doing axial flaps, it is not advisable to blindly ligate the blood vessels on the flap axis to avoid poor blood supply to the flap, delayed healing of the wound, and necrosis of the distal end of the flap or all of it. The defect at the nasal wing and nasal column can be repaired with the composite tissue flap of the auricle with a tip. 5%-15% of the nasofacial fractures have maxillary fractures at the same time, so the fractures of the nasal bone and maxillary frontal process should be carefully explored during the debridement, and when a fracture is found, it should be repositioned and fixed as much as possible in one phase, which is often operated under direct vision, so the repositioning is easy and the effect is better than the future phase II. When repositioning, care should be taken to restore the local anatomical level and not to separate the attached soft tissues of the fractured bone fragments too much, so as to avoid osteonecrosis or the formation of hematoma around the bone tissue and secondary infection. For fractures of small bone fragments, the nasal cavity is supported by filling after resetting and the external nose is fixed with an aluminum plastic plate nasal clip, which fixes the resumed bone fragments by internal filling and external compression, eliminates dead cavities in the tissue, and facilitates hemostasis to reduce postoperative swelling. For large bone tissue fractures, fixation with titanium plates and nails is required, otherwise displacement can easily occur. Fractures of the anterior skull, the hardest of the facial bones, suggest the occurrence of a large force (800 – 2000 lbs) trauma, so the clinician needs to be alert for other injuries that may have gone undetected. 13% – 33% of fractures of the anterior group of sinuses are associated with a nasal leak of cerebrospinal fluid, and intracranial trauma should be ruled out if necessary. The possibility of trauma should be ruled out if necessary. Severe trauma can produce a large penetration of the nasal septum, which should be repaired intraoperatively if possible, but perforation still occurred in one case in this group after surgery. To summarize the previous experience, it is recommended that all patients with severe trauma and suspected fractures should undergo CT examination to clarify whether the extent of trauma involves the intracranial and orbital areas, and if necessary, the relevant departments need to operate in collaboration. In patients with compound fractures of the nasal orbital sieve, the cooperation of an ophthalmologist is required to try to give repair in phase I to restore the function of the eye, reconstruct the tear duct and avoid intraocular invagination. In cases of nasal trauma with penetrating injuries or nasal bone fractures, nasal tamponade is required after debridement surgery. Careful and reasonable nasal tamponade is not only to play a good role in compression and hemostasis, but also to support the nasal structure. Good stuffing can effectively reduce the occurrence of postoperative nasal collapse, septal hematoma and deviation, nasal adhesions, etc., and facilitate the recovery of nasal shape and nasal physiological function. There are many materials for caulking, either with antibiotic eye ointment Vaseline gauze, or with expanding sponges. It is not advisable to use cotton balls or calcium alginate and other unsupportive or easily self-degradable materials to fill. The external nose is fixed with a nasal splint made of composite aluminum-plastic material, which facilitates external nose shaping and shape recovery and reduces swelling. If the soft tissue laceration near the anterior nostril is more than one-half of the nostril circumference, silicone tubes should be placed in the anterior nostril after extraction of the filler to avoid scar contraction and narrowing of the nostril for more than six months. In a word, comprehensive and meticulous examination before surgery, careful cleaning during surgery, reasonable use of surgical techniques, postoperative nasal stuffing and care, external nasal pressure fixation and other details determine the good or bad results of surgery. Good cooperation with doctors of related departments is also the key to achieve better results in the management of traumatic injuries of compound nasal face.