Nasal Fracture Treatment & Management

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

Acute Phase

Medical Issues/Complications

High-force midfacial injuries may involve structures other than the nose itself.

  • 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 anti-staphylococcal 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.

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.

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.

Proceed to Medication
 
 
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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  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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