Nasal Fracture Surgery Workup

  • Author: Vipul R Dev, MD; Chief Editor: Deepak Narayan, MD, FRCS   more...
 
Updated: Nov 28, 2011
 

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.
  • CT scan is also not routinely required. An exception is made for patients in whom more significant injuries are suggested.[3]
    • 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, 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: lifecell Honoraria Speaking and teaching; pfizer Honoraria Speaking and teaching

Coauthor(s)

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, 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.

Specialty Editor Board

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, 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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Darshan Patel to the development and writing of this article.

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. 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. Dec 2011;40(8):486-91. [Medline].

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

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

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

  7. 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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