10 / Post-concussion & TBI

Why Is My Nose Stuffy After a Head Injury? Sphenovomerine Suture Restriction

Cranial Solutions19 August 20256 min read

Persistent nasal congestion and facial sinus pressure after a head injury are associated with restriction of the facial sutures - in particular the sphenovomerine and palatomaxillary sutures. When impact energy travels through the skull, it may push the thin vomer bone (which forms the back of the nasal septum) into the base of the sphenoid bone. This compression may narrow the nasal airway, alter airflow and reduce drainage from the facial sinuses, associated with an ongoing stuffed-up feeling without active infection.

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The Biomechanical Problem: Impact Force Travelling to the Facial Bones

When a concussion or facial injury occurs, impact force does not stop at the forehead or jaw; it travels deep into the internal facial skeleton. The facial bones form a delicate network that helps spread impact energy away from the brain.

From Impact to Nasal Congestion

Step 1: Facial impact or head injury force.
Step 2: Force carried to the vomer and palatine bones.
Step 3: Sphenovomerine and palatomaxillary suture restriction.
Step 4: Nasal airway bottleneck and slowed sinus drainage.
Step 5: Associated sinus pressure, congestion and facial pain.

Key structural junctions in the nasal cavity include:

The sphenovomerine suture: the main joint where the vertical vomer bone meets the underside of the sphenoid bone.
The palatomaxillary seam: where the roof of the mouth (hard palate) meets the upper jaw and sphenoid processes.

A strong blow may drive the vomer bone upward and backward, restricting the sphenovomerine suture. This may narrow the internal nasal passage, reduce its minimal cross-sectional area (mCSA below 0.37 cm²) and increase airflow resistance.

See how head injury drivers are assessed on our Post-Concussion Symptoms & TBI page.

Comparison: Infective Sinusitis vs. Post-Injury Sutural Restriction

Primary cause

Common infective sinusitis: Viral or bacterial infection of the lining.
Post-injury sutural restriction: Restriction of the facial sutures.

Nasal discharge

Common infective sinusitis: Thick, discoloured green or yellow mucus.
Post-injury sutural restriction: Clear mucus, or stuffy with little mucus.

Response to antibiotics

Common infective sinusitis: Improves as the infection settles.
Post-injury sutural restriction: Often little change, as the structural narrowing remains.

Pressure location

Common infective sinusitis: Even facial heaviness during a cold.
Post-injury sutural restriction: One-sided facial pressure linked to a head injury.

Structural approach

Common infective sinusitis: Antihistamines, sprays or antibiotics.
Post-injury sutural restriction: Endonasal inflation (Nasal RX) may be discussed after assessment.

Clinical feature	Common infective sinusitis	Post-injury sutural restriction
Primary cause	Viral or bacterial infection of the lining.	Restriction of the facial sutures.
Nasal discharge	Thick, discoloured green or yellow mucus.	Clear mucus, or stuffy with little mucus.
Response to antibiotics	Improves as the infection settles.	Often little change, as the structural narrowing remains.
Pressure location	Even facial heaviness during a cold.	One-sided facial pressure linked to a head injury.
Structural approach	Antihistamines, sprays or antibiotics.	Endonasal inflation (Nasal RX) may be discussed after assessment.

How Facial Suture Restriction Is Associated With Symptoms

Sphenovomerine suture compression is associated with three distinct problems:

Airway Bottleneck

Narrowing of the internal nasal airway may increase airflow resistance, which is associated with ongoing mouth breathing.

Slowed Sinus Drainage

Compression of the facial bones may narrow the ostiomeatal complex (OMC), the main drainage pathway for the maxillary and frontal sinuses, associated with fluid build-up and facial pressure.

Referred Facial Pain

The facial sutures are supplied by the maxillary branch of the trigeminal nerve (CN V2). Suture compression may send ongoing signals felt as deep cheek, bridge-of-nose or upper tooth pain.

Blocked nose or facial pressure since a knock to the head? Read more on our Post-Concussion Symptoms & TBI page, or see

Nasal & Sinus Congestion.

Supporting Movement and Fluid Dynamics

Easing post-injury nasal congestion involves supporting movement in the compressed facial skeleton:

Endonasal inflation (Nasal RX): controlled, brief inflations within key inner nasal passageways apply gentle outward pressure to the sphenovomerine and palatomaxillary sutures.
Mobilising the vomer bone: easing the sphenovomerine suture aims to support a wider internal nasal passage.
Supporting sinus drainage: easing facial bone restriction aims to support natural drainage through the ostiomeatal complex and comfortable nasal breathing. Individual results vary.

Frequently Asked Questions

Why is my nose constantly stuffy after a concussion when I don't have a cold?

Head impacts may restrict the internal facial bones, particularly the vomer bone that forms part of the nasal septum. Compression at the sphenovomerine suture may narrow the internal airway, associated with a constant stuffy feeling even without mucus or infection. Learn more on our Post-Concussion Symptoms & TBI page.

Why haven't nasal sprays or antibiotics helped my post-concussion sinus pressure?

Antibiotics and sprays target bacteria or inflammation. They are not designed to address structural compression of the facial sutures. Where sinus pressure is associated with bone restriction after a head injury, a structural approach may be discussed after assessment. Read Why Am I Still Having Concussion Symptoms Months Later?

How does endonasal inflation work on the facial sutures?

Nasal RX uses brief, controlled inflations inside the nasal passageway that apply gentle pressure to the sphenoid, vomer and palatine bones. This aims to mobilise restricted sutures and support airway space. Suitability is discussed after individual assessment.

For the full overview, visit our Post-Concussion Symptoms & TBI page.

For airway and sinus symptoms, see Nasal & Sinus Congestion.

Read Why Am I Still Having Concussion Symptoms Months Later?

Also see Deep Nose Bone Blockages

Learn about our clinical approach.

Browse the published studies on our Research page.

References

01Dural Attachment Points & Sutures Report (2025). Sphenoid crista galli, clinoid processes, and petrous temporal ridge anchor mechanics.
02Glymphatic System Review (2022). Glymphatic System a Window on TBI Pathophysiology: A Systematic Review. Brain Sciences, 12(8): 940-958.
03Prevalence of Mechanical Strain Report (2025). Suture restriction, asymmetric traction, and cranial suture headache patterns.
04Levy D. (2009). Meningeal neurogenic inflammation, dural mast cell degranulation, and CGRP. Curr Pain Headache Rep, 13(3): 237-240.
05Mayo Clinic Suture Study (2020). Cranial suture headache syndrome originating from sutural trigeminal nociceptors. Mayo Clin Proc, 95(7): 1420-1428.

Learn how our non-surgical endonasal protocol is used to evaluate suitability for conservative management, and how cranial base structural mechanics guide an individual care plan.