Nasal fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File:F2.png|thumb|Normal anatomy of the nasal sinuses.]] | |||
*Always assess for associated head, face, and neck injuries | *Always assess for associated head, face, and neck injuries | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:BrokenNose.jpg|thumb|Displaced nasal fracture with epistaxis.]] | |||
*Nasal deformity, bony crepitus | *Nasal deformity, bony crepitus | ||
*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 | ||
==Pediatric Considerations== | ==Pediatric Considerations== | ||
* More cartilage present | * More cartilage present | ||
* Septal | * [[Septal hematoma]]s 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. | * Injuries heal more quickly, requiring followup in 7-10 days, whereas adults should seek specialist care in 2 weeks. | ||
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#Consider ED reduction (only if patient presents before significant swelling has occurred) | #Consider ED reduction (only if patient presents before significant swelling has occurred) | ||
#*Anesthesia | #*Anesthesia | ||
#**Place | #**Place [[lidocaine]] soaked cotton pledgets for 5 minutes | ||
#**Inject local | #**Inject [[local anesthetics]] | ||
#**Perform [[Nerve Block: Infraorbital|infraorbital]] and [[Nerve Block: supraorbital|supraorbital]] nerve block if needed | #**Perform [[Nerve Block: Infraorbital|infraorbital]] and [[Nerve Block: supraorbital|supraorbital]] nerve block if needed | ||
#*Reduction | #*Reduction | ||
Latest revision as of 19:50, 10 April 2024
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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Evaluation
- Clinical diagnosis (imaging rarely needed)
Management
Most nasal fractures do not require immediate intervention
- Exclude other associated traumatic injuries
- Treat septal hematoma if present
- Immediately incise and drain
- Consider ED reduction (only if patient presents before significant swelling has occurred)
- Anesthesia
- Place lidocaine soaked cotton pledgets for 5 minutes
- Inject local anesthetics
- Perform infraorbital and supraorbital nerve block 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
- Outpatient
- Refer to ENT within 6-10 days regardless of whether perform reduction or not
- No nose blowing