Fractured Nose

A fractured nose is the most common facial fracture. It usually results from blunt injury and is commonly associated with other facial fractures. The severity of the fracture depends on the direction, force, and type of the blow. A severe comminuted fracture may cause extreme swelling or bleeding that may jeopardize the airway and require a tracheotomy during early treatment.

Causes

Fractures of the nasal bones usually result from direct trauma. The causative injury can be relatively minor such as a fall, or more severe such as a motor vehicle accident.

Signs/Symptoms

Diagnostic tests

X-rays help to confirm the diagnosis and determine the extent of injury.

Treatment

The patient may not need treatment unless he has suffered bone displacement, septal deviation, or a cosmetic deformity.

When necessary, prompt treatment restores normal facial appearance and reestablishes bilateral nasal passages after swelling subsides. Reduction of the fracture (restoring the displaced bone fragments to their normal positions) corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose and taped) maintains it.

Nasal fractures should be reduced within the first 24 hours if possible, using local anesthesia for an adult and general anesthesia for a child. Severe swelling may delay treatment for several days to per week, making reduction more difficult. In this case, the patient may need general anesthesia.

If CSF leakage occurs, the patient needs close observation and antibiotic therapy. Septal hematoma requires incision and drainage to prevent necrosis.

Prevention

• Protective headgear should be worn while playing contact sports, riding bicycles, skateboards, roller-skates, or roller blades.
• DO NOT try to straighten a broken nose.
• Seatbelts and appropriate car seats should be used.
• Apply cold compresses to the nose to reduce swelling. If possible, the victim should hold the compress so that excessive pressure is not applied.

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