Nasal Fracture Clinical Presentation

  • Author: Samuel J Haraldson, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Dec 13, 2011
 

History

Any history of a fall or force directed toward the mid face should alert the clinician of a possible nasal fracture.

The clinician should obtain details of the injury, including the mechanism and location of injury as well as the direction of force. These details allow estimation of its severity.[4, 5, 10, 11]

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Physical

In cases of nasal fracture, there is evidence of trauma to the mid face. Often, deformity of the nose provides the greatest clue. Other signs include swelling, skin laceration, ecchymosis, epistaxis (bleeding from within the nose), and cerebrospinal fluid (CSF) rhinorrhea. Epistaxis implies mucosal disruption; this should increase the clinician's suspicion for a nasal fracture, including possible nasal septum fracture.

Internal examination

  • Acute edema may hide deformities; however, a careful search for intranasal injury must take place.
  • Adequate lighting must be available, and the patient should be placed in a comfortable, slightly reclined position. Bleeding can be controlled with topical cotton pledgets soaked in vasoconstrictors, such as 0.25% phenylephrine (Neo-Synephrine [Bayer HealthCare, Morristown, NJ] is also available as a spray) or 4% cocaine, which also provides anesthesia. Retained blood clots should be removed with suctioning or swabbing.
  • The clinician should search for any deformity or septal hematoma; however, septal deviation does not automatically determine fracture. An estimated 33-50% of the population normally has a septal defect.

Manipulation: A cotton-tipped swab should be placed in each naris up to the septum to check for deformity and mobility.

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Causes

See History, above.

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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Samuel J Haraldson, MD  Team Physician, Director of Sports Medicine, Medical Director of Athletic Training Education Program, Adjunct Clinical Professor, Department of Kinesiology, Texas Christian University

Samuel J Haraldson, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Society for Sports Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew L Sherman, MD, MS  Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Pfizer Honoraria Speaking and teaching

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

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Russell L. Reinbolt, MD and Robert D. Welch, MD, to the development and writing of this article.

References

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  2. Kim MG, Kim BK, Park JL, et al. The use of bioabsorbable plate fixation for nasal fractures under local anaesthesia through open lacerations. J Plast Reconstr Aesthet Surg. Jun 2008;61(6):696-9. [Medline].

  3. Erdmann D, Follmar KE, Debruijn M, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. Apr 2008;60(4):398-403. [Medline].

  4. Cantrill SV. Facial trauma. In: Rosen P, ed. Emergency Medicine: Concepts in Clinical Practice. Vol 1. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998:459.

  5. Smith JA. Nasal emergencies and sinusitis. In: Tintinalli JE, Ruiz E, Krome RL, eds. Emergency Medicine: A Comprehensive Study Guide. 4th ed. New York, NY: McGraw-Hill Publishing; 1996:1087-91.

  6. Coto NP, Meira JB, E Dias RB, Driemeier L, de Oliveira Roveri G, Noritomi PY. Assessment of nose protector for sport activities: finite element analysis. Dent Traumatol. Jul 26 2011;[Medline].

  7. Shirani G, Kalantar Motamedi MH, Ashuri A, Eshkevari PS. Prevalence and patterns of combat sport related maxillofacial injuries. J Emerg Trauma Shock. Oct 2010;3(4):314-7. [Medline]. [Full Text].

  8. Swenson DM, Yard EE, Collins CL, Fields SK, Comstock RD. Epidemiology of US high school sports-related fractures, 2005-2009. Clin J Sport Med. Jul 2010;20(4):293-9. [Medline].

  9. Hwang K, You SH, Lee HS. Outcome analysis of sports-related multiple facial fractures. J Craniofac Surg. May 2009;20(3):825-9. [Medline].

  10. Colton JJ, Beekhuis GJ. Management of nasal fractures. Otolaryngol Clin North Am. Feb 1986;19(1):73-85. [Medline].

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

  12. Bremke M, Wiegand S, Sesterhenn AM, et al. Digital volume tomography in the diagnosis of nasal bone fractures. Rhinology. Jun 2009;47(2):126-31. [Medline].

  13. Bianco M, Sanna N, Bucari S, et al. Female boxing in Italy: 2002-2007 report. Br J Sports Med. Aug 19 2009;epub ahead of print. [Medline].

  14. Procacci P, Ferrari F, Bettini G, et al. Soccer-related facial fractures: postoperative management with facial protective shields. J Craniofac Surg. Jan 2009;20(1):15-20. [Medline].

  15. We J, Kim Y, Jung T, et al. Modified technique for endoscopic endonasal reduction of medial orbital wall fracture using a resorbable panel. Ophthal Plast Reconstr Surg. Jul-Aug 2009;25(4):303-5. [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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