Nasal fracture: Difference between revisions

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==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


==Diagnosis==
==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==
{{Maxillofacial trauma DDX}}
 
==Evaluation==
*Clinical diagnosis (imaging rarely needed)
*Clinical diagnosis (imaging rarely needed)


==Treatment==
==Management==
''Most nasal fractures do not require immediate intervention''
#Exclude other associated traumatic injuries
#Exclude other associated traumatic injuries
#Treat septal hematoma
#Treat [[septal hematoma]] if present
##Immediately incise and drain
#*Immediately incise and drain
#Most nasal fractures do not require immediate intervention
#Consider ED reduction (only if patient presents before significant swelling has occurred)
##Can be managed by outpt ENT within 6-10d
#*Anesthesia
##Consider ED reduction only if pt presents before significant swelling has occurred
#**Place [[lidocaine]] soaked cotton pledgets for 5 minutes
###Anesthesia
#**Inject [[local anesthetics]]
####Place lidocaine soaked cotton pledgets for 5min
#**Perform [[Nerve Block: Infraorbital|infraorbital]] and [[Nerve Block: supraorbital|supraorbital]] nerve block if needed
####Inject local anesthetic
#*Reduction
####Perform infraorbital and supratrochlear regional blocks if needed
#**Insert elevator until contact is made with the depressed nasal bone
###Reduction
#**Lift depressed nasal bone anteriorly and laterally in one fluid motion
####Insert elevator until contact is made with the depressed nasal bone
#**Use external splinting and/or nasal packing to maintain alignment
####Lift depressed nasal bone anteriorly and laterally in one fluid motion
####Use external splinting and/or nasal packing to maintain alignment


==Disposition==
==Disposition==
#Refer to ENT within 6-10d regardless of whether perform reduction or not
*Outpatient
**Refer to ENT within 6-10 days regardless of whether perform reduction or not
**No nose blowing


==Source==
==See Also==
Tintinalli
*[[Septal hematoma]]
*[[Maxillofacial trauma]]


==References==
<references/>
[[Category:Trauma]]
[[Category:Trauma]]
[[Category:ENT]]
[[Category:ENT]]

Revision as of 21:20, 30 September 2019

Background

  • Always assess for associated head, face, and neck injuries

Clinical Features

Displaced nasal fracture with epistaxis.
  • 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

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