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

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
     • Place lidocaine soaked cotton pledgets for 5min
     • Inject local anesthetic
     • 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

Disposition

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