Nasal fractures generally occur as a result of an injury (e.g. sports injury, road traffic accident or assault).

Clinical Features:

The patient will usually present as an emergency with some or all of the following:-

• Epistaxis
• Deformity
  
• Local swelling and bruising
  
• Nasal obstruction
  
• Local tenderness
  
  

Investigations:

Generally, patients will have nasal x-rays taken, although it is possible to make a diagnosis without an x-ray.
X-rays and photographs may be useful as evidence in assault cases, or if the fracture is not recent.

Treatment:

Immediate:

• Cleaning and suturing/steri-stripping of any open wounds.
• If patient presents within two hours of injury, it may be possible to reduce fracture using local anaesthesia. Otherwise appointment given for reduction in 5 - 10 days time (see below)
  

5 - 10 days after fracture:

• Reduction/manipulation of nasal fracture under general anaesthetic.
• It is crucial that this procedure is carried out during the time span as above - i.e. after swelling has subsided and prior to fusion of nasal bones.
• The patient is admitted as a daycase.
• Following the procedure, plaster of paris cast is applied for 7 days.

10 days or more:

• As fusion of nasal bones will have occurred, a rhinoplasty is required to correct deformity.

Complications:

Septal haematoma: usually occurs as a result of fracture

• Haematoma requires drainage with either needle aspiration or incision and evacuation.
• The nose is then packed and antibiotics are given.
  

Nasal obstruction: due to deviated nasal septum.

• May require septoplasty
  

Anosmia: loss of sense of smell.

• If this occurs, sense of smell rarely returns.

References/Suggested Further Reading:

Karen Sumpter
Lead Nurse
Head & Neck Directorate
North West London Hospitals NHS Trust
karen.sumpter@nwlh.nhs.uk