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

• Le Fort fractures
• Skull fracture (peds)
• Auricular hematoma
• Nasal fracture
  • Nasal septal hematoma
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Dental trauma
• Mandible fracture

Orbital trauma

Acute

• Ruptured Globe^
• Corneal Abrasion
• Ocular foreign body
• Conjunctival laceration
• Caustic Keratoconjunctivitis^^
• Subconjunctival hemorrhage
• Traumatic iritis
• Traumatic hyphema
• Retinal detachment
• Retrobulbar hemorrhage/hematoma
• Traumatic mydriasis
• Orbital fracture
  • Frontal sinus fracture
  • Naso-ethmoid fracture
  • Inferior orbial wall fracture
  • Medial orbital wall fracture

Subacute/Delayed

• Endophthalmitis^
• Corneal Ulcer^

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
     • Place lidocaine soaked cotton pledgets for 5 minutes
     • 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 6-10 days regardless of whether perform reduction or not
  • No nose blowing

See Also

• Septal hematoma
• Maxillofacial trauma

References

Authors

Jordan Swartz, Ross Donaldson, Neil Young, Marissa Camilon