eMedicine Specialties > Sports Medicine > Face and Head

Nasal Fracture: Differential Diagnoses & Workup

Author: Samuel J Haraldson, MD, Team Physician, Director-Sports Medicine Advisory Team, Medical Director-Athletic Training Education Program, Texas Christian University, Fort Worth, TX
Coauthor(s): Russell L Reinbolt, MD, Staff Physician, Emergency Department, Sharp Memorial Hospital; Robert D Welch, MD, Director of Education, Assistant Professor, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University
Contributor Information and Disclosures

Updated: Jun 17, 2008

Differential Diagnoses

Contusions
Facial Fractures

Other Problems to Be Considered

Orbital floor and/or wall fractures
Septal hematoma

Workup

Laboratory Studies

  • In cases with a significant amount of bleeding or where a patient may require operative intervention, the following blood tests should be obtained:
    • Complete blood cell (CBC) count – To check baseline level of hemoglobin and platelet count
    • Coagulation studies (prothrombin time [PT] / activated partial thromboplastin time [aPTT])
    • Blood typing and cross-matching for packed red blood cells – In the event transfusion should be required

Related Medscape topics:
Resource Center Surgical Blood Management
Specialty Site Pathology & Lab Medicine
Specialty Site Surgery

Imaging Studies

  • Nearly 50% of nasal fractures are likely to be missed on plain film nasal radiographs. A high incidence of false-positive studies secondary to the complex anatomy of the developmental suture lines exists. Cartilaginous injury is not detected by radiographs; therefore, it is not considered routine to order nasal radiographs only when an isolated nasal fracture is suspected.
  • Facial x-ray series: If suspicion for other facial injury exists, then a complete facial radiographic series should be obtained.
  • Computed tomography (CT) scanning provides the best information regarding the extent of bony injury in nasal and facial fractures. Again, cartilaginous injury is likely to be missed.

Procedures

  • Closed reduction
    • Closed reduction of nasal fractures, including nasal septal fractures, should be performed by an otolaryngologist, plastic surgeon, or maxillofacial surgeon.
    • The repair technique requires specialized instruments and involves a reversal of forces that caused the injury.
    • An attempt at closed reduction of an obvious nasal deformity may be made in the acute setting by medical personnel who are trained in this procedure, in which only a gloved hand is used.

Related eMedicine topics:
Nasal and Septal Fractures
Nasal Fracture Reduction
Rhinoplasty, Basic Closed Technique
Rhinoplasty, Basic Open Technique

More on Nasal Fracture

Overview: Nasal Fracture
Differential Diagnoses & Workup: Nasal Fracture
Treatment & Medication: Nasal Fracture
Follow-up: Nasal Fracture
Multimedia: Nasal Fracture
References
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References

  1. Cavalcanti AL, Melo TR. Facial and oral injuries in Brazilian children aged 5-17 years: 5-year review. Eur Arch Paediatr Dent. Jun 2008;9(2):102-4. [Medline].

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

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

  8. Losken HW, van Aalst JA, Mooney MP, et al. Biodegradation of Inion fast-absorbing biodegradable plates and screws. J Craniofac Surg. May 2008;19(3):748-56. [Medline].

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Further Reading

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Keywords

nasal fracture, nose fracture, maxillofacial injury, facial trauma, facial fractures, septal hematoma, nerve entrapment, muscle entrapment, diplopia, blowout fracture, nasolacrimal duct injury, cribriform plate fracture, epistaxis, CSF rhinorrhea

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Contributor Information and Disclosures

Author

Samuel J Haraldson, MD, Team Physician, Director-Sports Medicine Advisory Team, Medical Director-Athletic Training Education Program, Texas Christian University, Fort Worth, TX
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.

Coauthor(s)

Russell L Reinbolt, MD, Staff Physician, Emergency Department, Sharp Memorial Hospital
Russell L Reinbolt, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, San Diego County Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Robert D Welch, MD, Director of Education, Assistant Professor, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University
Robert D Welch, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, Assistant Professor, Departments of Neurological Surgery, Orthopedics, and Rehabilitation, University of Miami
Andrew L Sherman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Henry T Goitz, MD, Chief, Sports Medicine, Associate Professor, Department of Orthopaedic Surgery, Medical College of Ohio
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.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, 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, Sports Medicine Fellowship Director, 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, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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