Nasal fracture: Difference between revisions
m (Rossdonaldson1 moved page Nasal Fracture to Nasal fracture) |
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| Line 6: | Line 6: | ||
*Profuse epistaxis | *Profuse epistaxis | ||
*Periorbital ecchymosis in the absence of other findings of orbital injury | *Periorbital ecchymosis in the absence of other findings of orbital injury | ||
==Differential Diagnosis== | |||
{{Maxillofacial trauma DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
*Clinical diagnosis (imaging rarely needed) | *Clinical diagnosis (imaging rarely needed) | ||
==Treatment== | ==Treatment== | ||
*Exclude other associated traumatic injuries | |||
*Treat septal hematoma | |||
**Immediately incise and drain | |||
*Most nasal fractures do not require immediate intervention | |||
**Can be managed by outpt ENT within 6-10d | |||
**Consider ED reduction only if pt presents before significant swelling has occurred | |||
***Anesthesia | |||
****Place lidocaine soaked cotton pledgets for 5min | |||
****Inject local anesthetic | |||
****Perform [[Nerve Block: Infraorbial]] and [[Nerve Block: supraorbital]] if needed | |||
***Reduction | |||
****Insert elevator until contact is made with the depressed nasal bone | |||
****Lift depressed nasal bone anteriorly and laterally in one fluid motion | |||
****Use external splinting and/or nasal packing to maintain alignment | |||
==Disposition== | ==Disposition== | ||
*Refer to ENT within 6-10d regardless of whether perform reduction or not | |||
*No nose blowing | |||
== | ==References== | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 02:53, 29 August 2015
Background
- Always assess for associated head, face, and neck injuries
Clinical Features
- Nasal deformity, bony crepitus
- Profuse epistaxis
- Periorbital ecchymosis in the absence of other findings of orbital injury
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Diagnosis
- Clinical diagnosis (imaging rarely needed)
Treatment
- Exclude other associated traumatic injuries
- Treat septal hematoma
- Immediately incise and drain
- Most nasal fractures do not require immediate intervention
- Can be managed by outpt ENT within 6-10d
- Consider ED reduction only if pt presents before significant swelling has occurred
- Anesthesia
- Place lidocaine soaked cotton pledgets for 5min
- Inject local anesthetic
- Perform Nerve Block: Infraorbial and Nerve Block: supraorbital if needed
- Reduction
- Insert elevator until contact is made with the depressed nasal bone
- Lift depressed nasal bone anteriorly and laterally in one fluid motion
- Use external splinting and/or nasal packing to maintain alignment
- Anesthesia
Disposition
- Refer to ENT within 6-10d regardless of whether perform reduction or not
- No nose blowing