Nasal Fracture

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

Pathopysiology

Resultant effect of nasal injury depends on
1 patients age (young more elastic)
2 Direction of injury
3 Force

Younger patients have more cartilage, hence less likely to sustain a fracture. If there is a fracture, it tends to be cartilaginous making it difficult to manipulate in to a better position

Frontal injury tends to give depressed fracture. may also give a septal fracture/ haematoma.

Lateral injury may give unilateral bone depression, contralateral bone deviation, septal fracture


Important Hx
Timing of injury- must be seen by a ENT surgeon within 1 week
Associated injury- CSF leak, Epistaxis, Facial fracture- diplopia, 
Past Hx- was there old nasal fracture, does the nose look different now (ensure the deviation is not an old injury)



Important aspects of examination
Examine the external appearance, note if its is a new deviation.
Palpate the fracture line is it tender- new injury
Examine intra nasally after decongestion (use Co phenyl or Otrivin spray) 
If the septum appear swollen check if it is a boggy swelling- i.e. palpate with a firm probe. If boggy this could be a haematoma. 
Look for other injuries
 facial fractures, check vision, check diplopia due to ocular muscle entrapment, Dental, Lefort Fractures

Swollen, L depressed, R deviated. Hence MUA needs elevation of the L side and push in of the R side. This would be done under GA by most. Splint is applied for some protection

Investigations
No need for XR for nasal fracture alone. If nose has changed shape it is likely to be a fracture that need MUA
if facial fracture is suspected need CT and Maxillofacial review



Treatment
if septal haematoma need drainage (by a ENT surgeon) followed by either suturing of the septum or packing to prevent recollection.

If Abscess- also need URGENT drainage, Drain placement and packing to prevent recollection and antibiotic cover

Drain as well as splints in place to prevent recollection

If a simple fracture- must refer for assessment by ENT. MUA should be planned within a week. Best done around 7th day once the swelling has improved. MUA is done under GA by most ENT surgeons these days.