Nasal Trauma

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

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

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

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

• Packing for 2–5 days is often helpful to help prevent re-formation of the hematoma

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