eMedicine Specialties > Sports Medicine > Face and Head

Nasal Fracture

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

Updated: Jun 17, 2008

Introduction

Background

Nasal fractures seen in participants of athletic activities occur as a result of direct blows in contact sports and as a result of falls. The nasal bones are the most commonly fractured bony structures of the maxillofacial complex.^1,2,3,4,5

The nasal bone's protruding position coupled with its relative lack of support predisposes it to fracture. Prompt appropriate treatment prevents functional and cosmetic changes. Because of the nose's central location and proximity to important structures, the clinician should carefully search for other facial injuries in the presence of facial fractures.

For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center, Sports Injury Center, and Back, Neck, and Head Injury Center. Also, see eMedicine's patient education articles, Facial Fracture and Broken Nose.

Related eMedicine topics:
Facial Fractures
Facial Trauma, Frontal Sinus Fractures
Facial Trauma, Maxillary and Le Fort Fractures
Facial Trauma, Sports-Related Injuries
Initial Evaluation and Management of Maxillofacial Injuries
Nasal and Septal Fractures

Related Medscape topics:
Resource Center Adolescent Medicine
Resource Center Exercise and Sports Medicine
Resource Center Trauma
CME/CE Examining the Ears, Nose, and Oral Cavity in the Older Patient
CME The Role of Surgical Audit in Improving Patient Management; Nasal Haemorrhage: an Audit Study

Frequency

United States

Nasal fractures occur nearly twice as often in males as in females. Athletic injuries and interpersonal altercations account for the greatest proportion of causes. Less common causes include falls and motor vehicle accidents.

In a retrospective study, Erdmann et al investigated the medical records of 437 patients with 929 facial fractures.³  These authors noted that the most common etiology of facial trauma was assault (36%), followed by motor vehicle collision (MVC, 32%), falls (18%), sports (11%), occupations (3%), and gunshot wounds (2%). Of the facial fractures sustained, the most common fracture type was nasal bone fracture.³

International

In a retrospective study of Brazilian children aged 5-17 years, Cavalcanti and Melo found that facial injuries were most frequent in males (78.1%; 3-fold more common than in females) aged 13-17 years (60.9%), and the most common causes of these injuries were falls (37.9%) and traffic accidents (21.1%).¹ Of the facial injuries, nasal fractures were also most common (51.3%), followed by the zygomatic-orbital complex (25.4%).

Functional Anatomy

The lay term nose consists of bone and cartilage. The nasal septum, a commonly injured structure, consists of the vomer, the perpendicular plate of the ethmoid, and the quadrangular cartilage. Paired protrusions from the frontal bones and the ascending processes of the maxilla complete the bony component. The upper lateral and lower lateral cartilages, as well as the cartilaginous septum, compose the nonbony portion.

The blood supply occurs via branches of the ophthalmic artery, the ethmoidal and dorsal arteries, the facial artery, the nasopalatine, the sphenopalatine, and the greater palatine arteries. Sensation results from many small nerve branches; the external surface superiorly receives sensation from the supratrochlear and infratrochlear nerves, and the inferior portion receives sensation from branches of the infraorbital and anterior ethmoidal nerves. Internally, sensation is supplied by branches of the anterior ethmoidal ganglion and the sphenopalatine ganglion.

Related eMedicine topics:
Facial Bone Anatomy
Nose Anatomy
Orbit Anatomy

Related Medscape topics:
Resource Center Vascular Surgery
Specialty Site Neurology & Neurosurgery
Specialty Site Ophthalmology
Facial Fractures May Be Safely Repaired in War Zones
Neuroimaging in Neuroophthalmology

Sport-Specific Biomechanics

Any force directed to the mid face, either frontally or laterally, can disrupt the nasal anatomy, causing bony or cartilaginous injury. Frontally directed forces must be greater than normal to cause bony injury because the upper and lower lateral cartilages absorb a great deal of impact.

Children are more likely to sustain cartilaginous injury for a variety of reasons. This is mainly because children have a greater proportion of cartilage to bone, and the cartilage provides increased protection from fracture. Children's bones are also more elastic than adults' bones. This explains the increased incidence of greenstick fractures in children (fracture without displacement).

Related Medscape topics:
Resource Center Adolescent Medicine
Resource Center Fracture
Resource Center Trauma
Specialty Site Pediatrics
Specialty Site Surgery

Clinical

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.^4,5,6,7

Related eMedicine topics:
Initial Evaluation and Management of CNS Injury
Initial Evaluation and Management of Maxillofacial Injuries
Initial Evaluation of the Trauma Patient

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.

Causes

See History, above.

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

Treatment

Acute Phase

Medical Issues/Complications

• Septal hematoma
  • This is a common and serious complication of nasal trauma. Septal hematomas are collections of blood in the subperichondrial space. This places pressure on the underlying cartilage, resulting in irreversible necrosis of the septum. The patient also becomes predisposed to infection. A saddle deformity may develop from loss of tissue.
  • Drainage procedure: Septal hematomas must be drained immediately upon their being found. Cotton pledgets soaked in 4% cocaine are used for topical anesthesia. A scalpel incision must be made to allow drainage. A small Penrose-type drain is placed to prevent reaccumulation. Finally, nasal packing is placed. The patient should be started on oral antibiotics with antistaphylococcal coverage.
• Blowout fractures
  • Orbital wall and orbital floor blowout fractures may occur.
  • Any abnormality of ocular anatomy or function should alert the clinician of the possibility of these injuries.
  • A common finding is extraocular muscle dysfunction, commonly characterized by the inability to look up on the affected side, suggesting entrapment of a nerve or muscle.
  • The presenting complaint may be diplopia.
• Nasolacrimal duct injury
  • The nasolacrimal complex lies in close proximity to the nasal bones.
  • High-force midfacial injuries or those resulting in comminuted fractures require a consultation with an ophthalmologist.
• Infection: Although rare, infections resulting from nasal fractures can cause serious complications. For this reason, patients should be placed on antibiotics with coverage for staphylococcal pathogens.
• Fracture of the cribriform plate
  • This type of injury may predispose to leakage of CSF, allowing rare but extremely serious complications such as meningitis, encephalitis, or brain abscess to follow.
  • Drainage of clear rhinorrhea immediately after trauma to the mid face and up to several days later should alert the clinician to the possibility of this associated fracture of the cribriform plate.

Related eMedicine topic:
Resource Center Wound Management

Surgical Intervention

High-force nasal trauma resulting in deformity from displaced fractures or dislocations or from comminuted fractures may require open reduction and/or fixation by a surgeon.

Related Medscape topics:
Resource Center Fracture
Resource Center Trauma
Specialty Site Surgery

Consultations

If specialists were not consulted for the initial patient visit, appropriate referral to an otolaryngologist, maxillofacial surgeon, or plastic surgeon for outpatient management is warranted.

Other Treatment

In the acute phase, the patient should apply ice to the nose and elevate the head to aid in reduction of any swelling present. Nasal decongestants are prescribed to help reduce swelling and mucosal congestion.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications and infections.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Amoxicillin and clavulanate (Augmentin)

Drug combination that treats bacteria resistant to beta-lactam antibiotics.

Dosing

Adult

875 mg PO bid for 5-7 d

Pediatric

25 mg/kg/d PO divided bid

>3 months: Base dosing protocol on amoxicillin content; due to different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable tab (250/62.5), do not use the 250-mg tab until child weighs >40 kg.

Interactions

Coadministration with warfarin or heparin increases the risk of bleeding.

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust the dose in renal impairment.

Penicillin VK (Pfizerpen)

Inhibits the biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached and most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Dosing

Adult

250-500 mg PO qid

Pediatric

25-50 mg/kg/d PO divided bid

Interactions

Probenecid may increase the effectiveness by decreasing clearance; tetracyclines are bacteriostatic, causing a decrease in the effectiveness of penicillins when administered concurrently.

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in the presence of renal impairment.

Clindamycin (Cleocin)

Lincosamide for treatment of serious skin and soft-tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking the dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. DOC in penicillin-allergic patients.

Dosing

Adult

150-300 mg PO qid

Pediatric

8-20 mg/kg/d PO divided tid/qid

Interactions

Increases the duration of neuromuscular blockade, induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption.

Contraindications

Documented hypersensitivity; regional enteritis, ulcerative colitis, hepatic impairment, antibiotic-associated colitis

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust the dose in the presence of severe hepatic dysfunction; no adjustment is necessary in the presence of renal insufficiency; associated with severe, and possibly, fatal colitis

Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa.

Dosing

Adult

160 mg TMP/800 mg SMZ PO bid

Pediatric

<2 mo: Do not administer

>2 mo: 1 tsp/10 kg/dose PO bid

Interactions

May increase PT duration when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase the blood levels of both drugs; coadministration of diuretics increases the incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with coadministration; may potentiate the effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase the levels of zidovudine

Contraindications

Documented hypersensitivity; megaloblastic anemia due to folate deficiency

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue at first appearance of a skin rash or sign of an adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in the presence of folate deficiency (eg, chronic alcoholics, elderly persons, those receiving anticonvulsant therapy, those with malabsorption syndrome); hemolysis may occur in G6PD deficient individuals; AIDS patients may not tolerate or respond to TMP-SMZ; caution in the presence of renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation

Decongestants

Decongestants reduce mucosal edema.

Phenylephrine (Neo-Synephrine)

Applied directly to nasal mucous membranes where it stimulates alpha-adrenergic receptors and causes vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.

Dosing

Adult

2 sprays each nostril bid/qid

Pediatric

1 spray each nostril qid (parent may need to administer)

Interactions

Bretylium may potentiate the action of vasopressors on adrenergic receptors, possibly resulting in arrhythmias.

MAOIs may significantly enhance the adrenergic effects of phenylephrine, and pressor response may be increased 2- to 3-fold.

Guanethidine may increase pressor response of direct-acting vasopressors, possibly resulting in severe hypertension.

Contraindications

Documented hypersensitivity; severe hypertension or ventricular tachycardia

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use topical decongestants for more than 3-5 d; caution in the presence of hyperthyroidism, coronary artery and ischemic heart disease, diabetes mellitus, increased intraocular pressure, or prostatic hypertrophy; because of the increase in vasoconstriction, hypertensive patients may experience change in blood pressure

Analgesics

Pain control is essential to quality patient care. Analgesics ensure patient comfort and promote pulmonary toilet.

Acetaminophen (Tylenol, Feverall, aspirin-free Anacin)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants. Effective in relieving mild to moderate acute pain; however, it has no peripheral anti-inflammatory effects. May be preferred in elderly patients because of fewer GI and renal side effects.

Dosing

Adult

325-650 mg PO/PR q4-6h or 1000 mg tid/qid; not to exceed 4 g/d

Pediatric

<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d

>12 years: 325-650 mg PO q4h; not to exceed 4 g/d

Interactions

Rifampin can reduce the analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity.

Contraindications

Documented hypersensitivity; known G6PD deficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity is possible in those with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in toxicity due to cumulative doses exceeding the recommended maximum dose

Hydrocodone and acetaminophen

Drug combination indicated for moderate to severe pain.

Dosing

Adult

1-2 tab or cap PO q4-6h prn pain

Pediatric

<12 y: 10-15 mg/kg/dose acetaminophen PO q4-6h prn; not to exceed 2.6 g/d acetaminophen

>12 y: 750 mg acetaminophen PO q4h; not to exceed 10 mg hydrocodone bitartrate per dose or 5 doses/24 h

Interactions

Coadministration with phenothiazine may decrease the analgesic effects; toxicity increases with CNS depressants or tricyclic antidepressants.

Contraindications

Documented hypersensitivity; high-altitude cerebral edema (HACE) or elevated intracranial pressure (ICP)

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

The tablets contain metabisulfite that may cause hypersensitivity; caution in patients who are dependent on opiates since this substitution may result in acute opiate-withdrawal symptoms; caution in the presence of severe renal or hepatic dysfunction; caution if taking in conjunction with acetaminophen as hepatotoxicity may result

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs have analgesic and antipyretic activities. The mechanism of action of these agents is not known, but NSAIDs may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation and various cell membrane functions. Treatment of pain tends to be patient specific.

Ibuprofen (Advil, Excedrin IB, Ibuprin, Motrin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Dosing

Adult

200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d

Pediatric

<6 months: Not established

6 months to 12 years: 4-10 mg/kg/dose PO tid/qid

>12 years: Administer as in adults

Interactions

Coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Do not recommend in the acute phase of an injury due to a theoretic increase in bleeding; caution in the presence of congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of coagulation abnormalities or during anticoagulant therapy

Anesthetics

Anesthetic agents are used to produce local anesthesia.

Cocaine 4%

Decreases membrane permeability to sodium ions, which, in turn, inhibits depolarization and blocks conduction of nerve impulses.

Use the lowest dose necessary to produce anesthesia. The 4% solution is available as a 4-mL unit-dose vial (total of 16 mg of cocaine) or 10-mL multidose vial (total of 40 mg cocaine).

Dosing

Adult

One 4 mL unit-dose vial, titrate to desired effect; not to exceed 0.5 mg/kg, (two 4-mL unit-dose vials or approximately 32 mg in a 70-kg adult)

Pediatric

Not established

Interactions

Increases toxicity of MAOIs

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in the presence of hypertension, cardiovascular disease, thyrotoxicosis; avoid use in traumatized mucosa and sepsis at the region of the intended application; do not inject; not recommended for use in pediatric patients on mucous membranes

Follow-up

Return to Play

Uncomplicated nondisplaced fractures should not prevent a patient who participates in noncontact sports from returning to play in 2 weeks. In healthy adults, fracture healing occurs in approximately 3 weeks. Athletes involved in contact sports should have adequate head and face protection for several weeks when returning to play.

Related Medscape topics:
Resource Center Adolescent Medicine
Resource Center Exercise and Sports Medicine
Resource Center Patient Safety

Complications

See Treatment, Acute Phase, Medical Issues/Complications.

Prevention

Nasal fractures in sports can be prevented with the use of helmets that have adequate face protection.

Prognosis

Most nondisplaced nasal fractures heal without cosmetic or functional deformity. Both open and closed reduction techniques produce a high rate of refractory cosmetic deformity, manifested by septal deviations. Many patients eventually require nasal-septal rhinoplasty.

See also the Cosmetic Surgery section in eMedicine's Otolaryngology & Facial Plastic Surgery book.

Related Medscape topic:
Resource Center Aesthetic Medicine

Miscellaneous

Medicolegal Pitfalls

• Failure to prescribe antibiotics in patients with epistaxis after sustaining nasal fractures
• Failure to diagnose and treat CSF rhinorrhea, in the setting of a clear nasal discharge after maxillofacial trauma
• Failure to involve consultants when there is evidence of facial deformity, orbital injury (entrapment), or CSF leaks

Related eMedicine topics:
CSF Rhinorrhea
Epistaxis
Facial Fractures
Facial Trauma, Maxillary and Le Fort Fractures
Facial Trauma, Nasoethmoid Fractures
Nasal and Septal Fractures
Orbital Floor Fracture
Orbital Fracture
Orbital Fracture, Medial Wall

Related Medscape topics:
Resource Center Fracture
Resource Center Medical Malpractice and Legal Issues
Resource Center Trauma

Multimedia

Media file 1: 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.

Media file 2: 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.

Media file 3: Lateral radiographic view of a minimally displaced nasal bone fracture.

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. 4^th 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. 4^th 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].

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

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.

© 1994- by Medscape.
All Rights Reserved
(http://www.medscape.com/public/copyright)