Nasal fracture

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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

Pediatric Considerations

  • More cartilage present
  • Septal hematomas are more common, as nasal septum is more at risk of injury
  • Injuries heal more quickly, requiring followup in 7-10 days, whereas adults should seek specialist care in 2 weeks.

Differential Diagnosis

Maxillofacial Trauma

Orbital trauma

Acute

Subacute/Delayed

Evaluation

  • Clinical diagnosis (imaging rarely needed)

Management

Most nasal fractures do not require immediate intervention

  1. Exclude other associated traumatic injuries
  2. Treat septal hematoma if present
    • Immediately incise and drain
  3. Consider ED reduction (only if patient presents before significant swelling has occurred)
    • Anesthesia
    • 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

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

See Also

References