eMedicine Specialties > Plastic Surgery > Facial Fractures

Facial Trauma, Nasal Fractures: Workup

Author: Vipul R Dev, MD, Chief Medical Director, Regional Wound Care Center; Chief Executive Officer, California Institute of Cosmetic and Reconstructive Surgery; Director, HealtheUniverse, Inc
Coauthor(s): Patrick Byrne, MD, Assistant Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University; Adel R Tawfilis, DDS, Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center; David W Kim, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of California at San Francisco
Contributor Information and Disclosures

Updated: Sep 26, 2008

Workup

Laboratory Studies

  • Measure hemoglobin values as indicated, particularly if significant epistaxis present.

Imaging Studies

  • Imaging studies are rarely needed in the evaluation of nasal fractures.
  • Plain films are often obtained in emergency departments, but the diagnosis is made based on physical examination findings. As many as 47% of patients with nasal fractures have negative findings on x-ray films.
  • CT scan is also not routinely required. An exception is made for patients in whom more significant injuries are suggested.
    • The force applied to the mid face may cause Le Fort or other midface fractures, orbital blowouts, and naso-orbito-ethmoid complex fractures. In patients with the latter, a CSF leak is possible, with CSF rhinorrhea. Nasal fractures are often associated with such severe injuries.
    • The decision to order CT scans is made based on the history and associated physical examination findings that raise the physician's index of suspicion regarding associated injuries.

More on Facial Trauma, Nasal Fractures

Overview: Facial Trauma, Nasal Fractures
Workup: Facial Trauma, Nasal Fractures
Treatment: Facial Trauma, Nasal Fractures
Follow-up: Facial Trauma, Nasal Fractures
References
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References

  1. Murray JA, Maran AG, Mackenzie IJ, Raab G. Open v closed reduction of the fractured nose. Arch Otolaryngol. Dec 1984;110(12):797-802. [Medline].

  2. Sargent, LA. Nasoethmoid orbital fractures: diagnosis and treatment. Plastic Reconstr. Surg. Dec 2007(7 suppl 2). 16s-31s. [Medline]. [Full Text].

  3. Illum P. Long-term results after treatment of nasal fractures. J Laryngol Otol. Mar 1986;100(3):273-7. [Medline].

  4. Rohrich RJ, Adams WP Jr. Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg. Aug 2000;106(2):266-73. [Medline].

  5. Bailey BJ. Nasal fractures. In: Bailey BJ. Head and Neck Surgery - Otolaryngology. Vol 1. Philadelphia, Pa: JB Lippincott; 1993:991-1007.

  6. Pollock RA. Nasal trauma. Pathomechanics and surgical management of acute injuries. Clin Plast Surg. Jan 1992;19(1):133-47. [Medline].

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Further Reading

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Keywords

nasal fractures, nasal trauma, nasal fracture, broken nose, blunt trauma, facial trauma, closed reduction, open reduction, nasal fracture reduction, CSF leak, nasal epistaxis, bloody nose, nasal break, nasoethmoid fracture, blunt force trauma, frontal force, trauma, septal deviation, deviated septum, nasal obstruction, lateral force, nasal depression, nasal bone, nasal bone fracture, buckled nose

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Contributor Information and Disclosures

Author

Vipul R Dev, MD, Chief Medical Director, Regional Wound Care Center; Chief Executive Officer, California Institute of Cosmetic and Reconstructive Surgery; Director, HealtheUniverse, Inc
Vipul R Dev, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, Association for Academic Surgery, California Medical Association, National Medical Association, Sigma Xi, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Patrick Byrne, MD, Assistant Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University
Patrick Byrne, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Adel R Tawfilis, DDS, Assistant Clinical Professor, Department of Surgery, Division of Plastic Surgery, University of California at San Diego Medical Center
Adel R Tawfilis, DDS is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Society of Maxillofacial Surgeons
Disclosure: Nothing to disclose.

David W Kim, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Director, Division of Facial Plastic and Reconstructive Surgery, University of California at San Francisco
David W Kim, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

James F Thornton, MD, Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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