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Nasal Fracture Surgery Workup

  • Author: Vipul R Dev, MD; Chief Editor: Deepak Narayan, MD, FRCS  more...
 
Updated: Mar 18, 2016
 

Laboratory Studies

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

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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. However, see the images below.

Lateral radiographic view of a displaced nasal bon Lateral radiographic view of a displaced nasal bone fracture in a patient who sustained this injury because of a punch to the face during a hockey game.
Lateral radiographic view of a nasal bone fracture Lateral radiographic view of a nasal bone fracture in an elderly patient who fell forward on her face as a result of syncope. Marked comminution is present.
Lateral radiographic view of a minimally displaced Lateral radiographic view of a minimally displaced nasal bone fracture.

CT scan is also not routinely required. An exception is made for patients in whom more significant injuries are suggested.[4] 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.

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Contributor Information and Disclosures
Author

Vipul R Dev, MD Chief Medical Director, California Institute of Cosmetic and Reconstructive Surgery; Director, Regional Wound Care Center; Chief Executive Officer, 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, Texas Society of Plastic Surgeons

Disclosure: Received honoraria from lifecell for speaking and teaching; Received honoraria from pfizer for speaking and teaching.

Coauthor(s)

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, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Patrick Byrne, MD Associate Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine

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, American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, Texas Society of Plastic Surgeons

Disclosure: Received none from Allergan for speaking and teaching; Received none from LifeCell for consulting; Received grant/research funds from GID, Inc. for other.

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, Plastic Surgery Research Council, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Indian Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

James F Thornton, MD Associate Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

Darshan Patel Research Assistant, Undergraduate Biochemistry and Cell Biology, Rice Quantum Institute

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.

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

  3. Sargent LA. Nasoethmoid orbital fractures: diagnosis and treatment. Plast Reconstr Surg. 2007 Dec. 120 (7 Suppl 2):16S-31S. [Medline].

  4. Javadrashid R, Khatoonabad M, Shams N, Esmaeili F, Jabbari Khamnei H. Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures. Dentomaxillofac Radiol. 2011 Dec. 40(8):486-91. [Medline].

  5. Yi CR, Kim YJ, Kim H, et al. Comparison study of the use of absorbable and nonabsorbable materials as internal splints after closed reduction for nasal bone fracture. Arch Plast Surg. 2014 Jul. 41(4):350-4. [Medline]. [Full Text].

  6. Yu SS, Cho PD, Shin HW, Rhee SC, Lee SH. A Comparison Between K-Wire Splinting and Intranasal Gauze Packing in Nasal Bone Fracture. J Craniofac Surg. 2015 Jul. 26 (5):1624-7. [Medline].

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

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

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

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

 
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Lateral radiographic view of a displaced nasal bone fracture in a patient who sustained this injury because of a punch to the face during a hockey game.
Lateral radiographic view of a nasal bone fracture in an elderly patient who fell forward on her face as a result of syncope. Marked comminution is present.
Lateral radiographic view of a minimally displaced nasal bone fracture.
 
 
 
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