Nasal fracture

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
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

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

Disposition

• Refer to ENT within 6-10d regardless of whether perform reduction or not
• No nose blowing