Similar Fracture Patterns in Human Nose and Gothic Cathedral

Abstract

This study proposes that the bony anatomy of the human nose and masonry structure of the Gothic cathedral are geometrically similar, and have common fracture patterns. We also aim to correlate the fracture patterns observed in patients' midface structures with those seen in the Gothic cathedral using computational approach. CT scans of 33 patients with facial fractures were examined and compared with computer simulations of both the Gothic cathedral and human nose. Three similar patterns were found: (1) Cracks of the nasal arch with crumpling of the vertical buttresses akin to the damage seen during minor earthquakes; (2) lateral deviation of the central nasal arch and collapse of the vertical buttresses akin to those due to lateral forces from wind and in major earthquakes; and (3) Central arch collapse seen as a result of collapse under excessive dead weight. Interestingly, the finding of occult nasal and septal fractures in the mandible fractures with absence of direct nasal trauma highlights the possibility of transmission of forces from the foundation to the arch leading to structural failure. It was also found that the structural buttresses of the Gothic cathedral delineate the vertical buttresses in the human midface structure. These morphologic similarities between the human nose and Gothic cathedral will serve as a basis to study the biomechanics of nasal fractures. Identification of structural buttresses in a skeletal structure has important implications for reconstruction as reestablishment of structural continuity restores normal anatomy and architectural stability of the human midface structure.

Keywords

nasal fracture - maxillofacial injury - CT - finite element - head model

• References

• 1 Rohrich RJ, Adams Jr WP. Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg 2000; 106 (2) 266-273
• 2 Fettman N, Sanford T, Sindwani R. Surgical management of the deviated septum: techniques in septoplasty. Otolaryngol Clin North Am 2009; 42 (2) 241-252 , viii
• 3 Hilloowala R, Kanth H. The transmission of masticatory forces and nasal septum: structural comparison of the human skull and Gothic cathedral. Cranio 2007; 25 (3) 166-171
• 4 Lourenço PB. Analysis of historical constructions: From thrust lines to advanced simulations. In: Lourenço PB, Roca P, eds. Historical Constructions. Guimarães, Portugal: Balkema; 2001: 91-116
• 5 Roca P, Molins C. Computer analysis of a Gothic cathedral. Engenharia Civil Conference 2000; 9: 29-38
• 6 Tse KM, Tan LB, Lee SJ, Lim SP, Lee HP. Development and validation of two subject-specific finite element models of human head against three cadaveric experiments. Int J Numer Methods Biomed Eng 2014; 30 (3) 397-415
• 7 Tse KM, Tan LB, Lee SJ, Lim SP, Lee HP. Investigation of the relationship between facial injuries and traumatic brain injuries using a realistic subject-specific finite element head model. Accid Anal Prev 2015; 79 (0) 13-32
• 8 Wilson C. The Gothic Cathedral: The Architecture of the Great Church. London, UK: Thames and Hudson; 1990
• 9 Mark R. Experiments in Gothic Structure. Cambridge, MA: The MIT Press; 1982
• 10 Fitchen J. The Construction of Gothic Cathedrals: A Study of Medieval Vault Erection. Oxford, UK: Clarendon Press; 1961
• 11 Murray JA, Maran AG. The treatment of nasal injuries by manipulation. J Laryngol Otol 1980; 94 (12) 1405-1410
• 12 Rhee SC, Kim YK, Cha JH, Kang SR, Park HS. Septal fracture in simple nasal bone fracture. Plast Reconstr Surg 2004; 113 (1) 45-52
• 13 Renner GJ. Management of nasal fractures. Otolaryngol Clin North Am 1991; 24 (1) 195-213
• 14 Pollock RA. Nasal trauma. Pathomechanics and surgical management of acute injuries. Clin Plast Surg 1992; 19 (1) 133-147
• 15 Adamson JE, Horton CE, Crawford HH, Taddeo RJ. Acute submucous resection. Plast Reconstr Surg 1968; 42 (2) 152-154
• 16 Harrison DH. Nasal injuries: their pathogenesis and treatment. Br J Plast Surg 1979; 32 (1) 57-64
• 17 Willinger R, Taleb L, Kopp CM. Modal and temporal analysis of head mathematical models. J Neurotrauma 1995; 12 (4) 743-754
• 18 Ruan JS, Khalil T, King AI. Dynamic response of the human head to impact by three-dimensional finite element analysis. J Biomech Eng 1994; 116 (1) 44-50
• 19 Markowitz BL, Manson PN. Panfacial fractures: organization of treatment. Clin Plast Surg 1989; 16 (1) 105-114
• 20 Gruss JS, Mackinnon SE. Complex maxillary fractures: role of buttress reconstruction and immediate bone grafts. Plast Reconstr Surg 1986; 78 (1) 9-22
• 21 Manson PN, Hoopes JE, Su CT. Structural pillars of the facial skeleton: an approach to the management of Le Fort fractures. Plast Reconstr Surg 1980; 66 (1) 54-62
• 22 Manson PN, Glassman D, Vanderkolk C, Petty P, Crawley WA. Rigid stabilization of sagittal fractures of the maxilla and palate. Plast Reconstr Surg 1990; 85 (5) 711-717
• 23 Roca P, Clemente R. Studies on the origin of deformation and damage in long-span historical structures. In: Lourenço PB, Roca P, Eds. Historical Constructions. Guimarães, Portugal: Balkema; 2001