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

  • 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