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For further information, see CMDT Part 8-14: Nasal Trauma

Key Features

  • The nasal pyramid is the most frequently fractured bone in the body

  • Epistaxis and pain are common, as are soft tissue hematomas ("black eye")

  • Septal hematomas may become infected; Staphylococcus aureus is most common organism

  • Persistent functional or cosmetic defects may be repaired by delayed reconstructive nasal surgery

Clinical Findings

  • Fracture is suggested by crepitance or palpably mobile bony segments

  • Intranasal examination should be performed in all cases to rule out septal hematoma, which appears as a widening of the anterior septum, visible just posterior to the columella. The septal cartilage receives its only nutrition from its closely adherent mucoperichondrium

  • It is important to ensure that there is no palpable step-off of the infraorbital rim, which would indicate the presence of a zygomatic complex fracture

Diagnosis

  • Radiologic confirmation may be helpful but is not necessary in uncomplicated nasal fractures

Treatment

  • Treatment is aimed at maintaining long-term nasal airway patency and cosmesis

  • Closed reduction can be performed under local or general anesthesia

  • Infected septal hematomas

    • Should be drained with an incision in the inferior mucoperichondrium on both sides and fluid sent for culture

    • Antibiotics with anti-staphylococcal efficacy (eg, cephalexin, 500 mg four times daily, or clindamycin, 150 mg four times daily) should be given for 3–5 days to reduce risk of toxic shock syndrome

  • An untreated subperichondrial hematoma will result in loss of the nasal cartilage with resultant saddle-nose deformity

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