Nasal Fracture Clinical Presentation

Updated: Dec 06, 2018
  • Author: Samuel J Haraldson, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

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, 12, 13, 25]

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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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