Nasal fracture: Difference between revisions
| (10 intermediate revisions by 5 users not shown) | |||
| Line 1: | Line 1: | ||
==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== | |||
* More cartilage present | |||
* [[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. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Maxillofacial trauma DDX}} | {{Maxillofacial trauma DDX}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis (imaging rarely needed) | *Clinical diagnosis (imaging rarely needed) | ||
== | ==Management== | ||
''Most nasal fractures do not require immediate intervention'' | ''Most nasal fractures do not require immediate intervention'' | ||
#Exclude other associated traumatic injuries | #Exclude other associated traumatic injuries | ||
#Treat septal hematoma if present | #Treat [[septal hematoma]] if present | ||
#*Immediately incise and drain | #*Immediately incise and drain | ||
#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 lidocaine soaked cotton pledgets for | #**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 | ||
| Line 31: | Line 37: | ||
==Disposition== | ==Disposition== | ||
*Outpatient | *Outpatient | ||
**Refer to ENT within 6- | **Refer to ENT within 6-10 days regardless of whether perform reduction or not | ||
**No nose blowing | **No nose blowing | ||
==See Also== | |||
*[[Septal hematoma]] | |||
*[[Maxillofacial trauma]] | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:ENT]] | [[Category:ENT]] | ||
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