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:
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Complete blood cell (CBC) count – To check baseline level of hemoglobin and platelet count
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Coagulation studies (prothrombin time [PT] / activated partial thromboplastin time [aPTT])
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Blood typing and cross-matching for packed red blood cells – In the event transfusion should be required
Imaging Studies
See the list below:
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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.
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Facial x-ray series: If suspicion for other facial injury exists, then a complete facial radiographic series should be obtained.
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Computed tomography (CT) scanning provides the best information regarding the extent of bony injury in nasal and facial fractures, particularly digital volume tomography (DVT). [14] Again, cartilaginous injury is likely to be missed.
Procedures
Closed reduction
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Closed reduction of nasal fractures, including nasal septal fractures, should be performed by an otolaryngologist, plastic surgeon, or maxillofacial surgeon.
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The repair technique requires specialized instruments and involves a reversal of forces that caused the injury.
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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.
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A study investigated the minimal and optimal duration of the nasal packing following reduction surgery of nasal bone fracture. The study demonstrated that 1-day packing had comparable postoperative outcome with reducing the patients' discomfort. A longer packing duration was not needed to achieve stable results and the study concluded that 1-day is a reasonable packing time for most nasal bone fractures. [15]
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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.
