Don’t bother with X–rays, diagnosis is made on clinical grounds. If it looks asymmetrical (and didn’t before) and especially if it has crepitus on palpation, it’s broken. It is vital to examine the interior of the nose. Check for other associated facial injuries.
Treatment of Nasal Trauma
Reduction is only necessary if the patient perceives a deformity or a new nasal airway obstruction, and can often be done under local anesthesia.
Closed reduction
This is best done immediately (within a few hours of injury) or at five to seven days, once the swelling is subsiding. Typically, a long instrument is inserted into the nose, under the nasal bones, and depressed bones are elevated. Sometimes special nasal fracture forceps (Ash Forceps) are employed.
Open reduction
This is basically a rhinoplasty +/− septoplasty. This is best done once the swelling is down (i.e. late treatment).
Complications with Nasal Trauma
Epistaxis: Watch out for brisk uncontrollable bleeding, it could be any of the following:
- Anterior ethmoidal artery avulsion.
- Septal hematoma.
- Saddle nose deformity.
- Persisting esthetic deformity.
- Nasal airway obstruction.
