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For further information, see CMDT Part 8-14: Nasal Trauma
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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
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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
Assess for possible concomitant additional facial, spine, pulmonary, or intracranial injuries when the circumstances of injury are suggestive, as in the case of automobile and motorcycle accidents
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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, septal perforation, or both