Acute Phase
Medical Issues/Complications
High-force midfacial injuries may involve structures other than the nose itself.
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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.
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Orbital wall and orbital floor blowout fractures may occur. [23]
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.
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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.
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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.
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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.
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.
Prevention
Nasal fractures in sports can be prevented with the use of helmets that have adequate face protection.
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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.
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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.
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Lateral radiographic view of a minimally displaced nasal bone fracture.
