Nasal fractures are the most commonly encountered facial fracture, often resulting from sports, combat, falls or interpersonal violence. If displaced, a short window exists for acute reduction (ideally within two weeks) which can help restore functional and aesthetic outcomes. Delayed review after this two-week window risks a late or missed attempted manipulation. This risks poor patient outcomes, including the potential for future surgical reconstruction. This poster highlights key points of assessment of displaced nasal fractures from an ENT perspective at a major trauma hospital, with supporting broader literature.
Key clinical assessment includes evaluation of the nasal bones and nasal pyramid, nasal septum, and assessing for new functional symptoms (i.e. nasal obstruction, epistaxis). Acute complications which warrant urgent same day review include suspected septal haematoma requiring drainage, concurrent orbital involvement and skull base injury with CSF leak. Upon suspicion of these acute complications, or high-velocity mechanism or nasoethmoidal fracture, cross sectional imaging (thin-cut CT non contrast) is recommended.
For isolated displaced nasal bone fractures and/or external cartilaginous deviation reduction under local anaesthetic (LA) within 14 days may be offered for appropriate patients. If LA manipulation fails, general anaesthetic manipulation maybe required. In the setting of acute uncontrolled epistaxis acute reduction may achieve haemostasis (often from an anterior ethmoidal artery injury). Septal manipulation is not recommended under LA in an acute trauma setting. Variations of local blocks are described. If initial presentation is outside of the acute reduction window, 6-weeks should be allowed for healing before consideration of a septorhinoplasty under general anaesthesia.