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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

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

    • 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 or duration of the packing 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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