eMedicine Specialties > Clinical Procedures > Otolaryngologic and Dental Procedures

Nasal Fracture Reduction

Author: Oliver Mayorga, MD, Staff Physician, Department of Emergency Medicine, Lawrence and Memorial Hospital
Coauthor(s): Natalie Penelope Higgins, MD, Consultant Otolaryngologist, Fallon Clinic at Worcester Medical Center; Marvin P Fried, MD, FACS, Professor and University Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Jul 17, 2009

Introduction

Nasal bone fractures are among the most common facial bone fractures.1 According to several retrospective studies, nasal bone fractures comprise up to 50% of all facial fractures. The prototypical patient is a male aged 15-30 years who was involved in a fight, motor vehicle accident, or fall.2

Practitioners must understand the anatomy of the nasal bones before attempting any manipulation. The paired nasal bones project from the frontal processes of the maxilla, superiorly from the nasal process of the frontal bone, and join in the midline. The quadrangular, or septal, cartilage supports the nasal bones from below.

Nasal bone anatomy.

Nasal bone anatomy.

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Nasal bone anatomy.

Nasal bone anatomy.


Approximately 80% of nasal fractures occur between the thicker proximal and thinner distal segments of the nasal bones. Although frontal impact can cause fracture of the nasal bones, lateral impacts are more common. These lateral impact injuries typically cause a depression of one nasal bone and may result in a lateral displacement of the contralateral nasal bone.2

Diagnosis

  • Most nasal fractures are diagnosed by history and physical examination.
  • History usually includes a preexisting trauma, which may be followed by epistaxis. Typically, the epistaxis has resolved by the time the patient presents for intervention.
  • Patients usually present with swelling over the nasal bridge and a difference in the appearance or shape of the nose.
  • Physical examination findings include swelling over the nasal bridge, grossly apparent deviation of the nasal bones, and periorbital ecchymosis.
  • Plain radiographs are not helpful in the diagnosis or management of nasal fractures in isolated nasal injury.3
  • Nasal bone CT scan is helpful if the patient has associated facial fractures.4
  • Be sure to ask the patient how the external shape of the nose has changed since the fracture. This helps determine what corrective maneuvers should be taken to restore the patient’s appearance through reduction of the nasal fracture.

Indications

  • Simple fracture of the nasal bones or nasal-septal complex
  • Nasal obstruction or airway compromise from deviated nasal bones
  • Fracture of the nasal-septal complex with nasal deviation less than one half the width of the nasal bridge5
  • Reduction less than 3 hours after injury in adults and children (if minimal edema is present)
  • Reduction 6-10 days after injury in adults (after edema has resolved and before the setting of fracture fragments)6
  • Reduction 3-7 days after injury in children (after edema has resolved and before the setting of fracture fragments)

Contraindications

  • Severe comminution of the nasal bones and septum
  • Associated orbital wall or ethmoid bone fractures2
  • Nasal pyramid deviation that exceeds one half the width of the nasal bridge
  • Caudal septum fracture dislocation
  • Open septal fractures
  • Fractures examined 3 weeks or longer after the injury occurred

More on Nasal Fracture Reduction

Overview: Nasal Fracture Reduction
Treatment & Medication: Nasal Fracture Reduction
Multimedia: Nasal Fracture Reduction
References
Further Reading
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References

  1. Atighechi S, Karimi G. Serial nasal bone reduction: a new approach to the management of nasal bone fracture. J Craniofac Surg. Jan 2009;20(1):49-52. [Medline].

  2. Green KM. Reduction of nasal fractures under local anaesthetic. Rhinology. 2001;39(1):43-46.

  3. Lee KJ. Essential Otolaryngology: Head and Neck Surgery. 8th ed. New York, NY: McGraw-Hill; 2003:717-718.

  4. Kucik CJ, Clenney T, Phelan J. Management of acute nasal fractures. Am Fam Physician. Oct 1 2004;70(7):1315-20. [Medline].

  5. Bailey BJ. Head and Neck Surgery: Volume 1. Philadelphia, PA: J.B. Lippincott Co; 1993:443-446.

  6. Kerr AG. Scott-Brown's Otolaryngology. 6th. Oxford, England: Butterworth-Heinemann; 1997:4/16/6-4/16/11.

  7. DeFatta RJ, Ducic Y, Adelson RT, Sabatini PR. Comparison of closed reduction alone versus primary open repair of acute nasoseptal fractures. J Otolaryngol Head Neck Surg. Aug 2008;37(4):502-6. [Medline].

  8. Paparella MM, Shumrick DA, Gluckman JL, Meyerhoff WL. Nasal Fractures. In: Otolaryngology. 3rd ed. Philadelphia, PA: WB Saunders Co; 1991:1823-1830.

  9. Cummings CW, Fredrickson JM, Harker LA, et al. Nasal Fractures. In: Otolaryngology Head & Neck Surgery. 3rd ed. St. Louis, MO: Mosby; 1998:866-882.

  10. Jones TM, Nandapalan V. Manipulation of the fractured nose: a comparison of local infiltration anaesthesia and topical local anaesthesia. Clin Otolaryngol Allied Sci. Sep 1999;24(5):443-6. [Medline].

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Further Reading

American Family Physician: Management of Acute Nasal Fractures

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Keywords

nasal fracture reduction, nasal fracture, septal hematoma, facial trauma, nasal bone fracture, lateral nasal impact, frontal nasal impact, lateral displacement, contralateral nasal bone, nasal-septal complex, deviated nasal bones, nasal speculum, nasal pyramid fracture, nasal septum reduction, intranasal packing, closed nasal reduction, nasal bridge deviation

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Contributor Information and Disclosures

Author

Oliver Mayorga, MD, Staff Physician, Department of Emergency Medicine, Lawrence and Memorial Hospital
Oliver Mayorga, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Natalie Penelope Higgins, MD, Consultant Otolaryngologist, Fallon Clinic at Worcester Medical Center
Natalie Penelope Higgins, 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, and American Medical Association
Disclosure: Nothing to disclose.

Marvin P Fried, MD, FACS, Professor and University Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine
Marvin P Fried, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, American Society of Plastic and Reconstructive Surgery, Massachusetts Medical Society, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Entrigue Consulting fee Board membership

Medical Editor

Prajoy P Kadkade, MD, Assistant Professor, Department of Otolaryngology and Communicative Disorders, North Shore University Hospital-Long Island Jewish Hospital System, Albert Einstein College of Medicine
Prajoy P Kadkade, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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