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

Diagnosis

• Clinical diagnosis (imaging rarely needed)

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

Treatment

1. Exclude other associated traumatic injuries
2. Treat septal hematoma
   1. Immediately incise and drain
3. Most nasal fractures do not require immediate intervention
   1. Can be managed by outpt ENT within 6-10d
   2. Consider ED reduction only if pt presents before significant swelling has occurred
      1. Anesthesia
         1. Place lidocaine soaked cotton pledgets for 5min
         2. Inject local anesthetic
         3. Perform Nerve Block: Infraorbial and Nerve Block: supraorbital if needed
      2. Reduction
         1. Insert elevator until contact is made with the depressed nasal bone
         2. Lift depressed nasal bone anteriorly and laterally in one fluid motion
         3. Use external splinting and/or nasal packing to maintain alignment

Disposition

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

Source

Tintinalli