From the Guidelines
Management of acute nondisplaced fractures of the bilateral nasal bone tips primarily involves conservative treatment since these fractures typically heal well without surgical intervention. This approach is supported by the principle that simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as noted in a study on heel pain management 1, which although not directly related to nasal fractures, underscores the general medical principle of conservative management for nondisplaced or minimally displaced fractures.
Key Management Strategies
- Initial management includes ice application for 15-20 minutes every 1-2 hours for the first 24-48 hours to reduce swelling and pain.
- Pain control can be achieved with acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours with food) for 3-5 days as needed.
- Nasal congestion can be managed with saline nasal sprays and avoiding nose blowing for 2 weeks to prevent displacement.
- The patient should sleep with the head elevated and avoid contact sports or activities that risk nasal trauma for 4-6 weeks.
Follow-Up and Potential Complications
Follow-up should occur within 5-7 days to reassess alignment and healing. Most nondisplaced nasal fractures heal within 3-4 weeks without complications. If significant cosmetic concerns or breathing difficulties develop, referral to an otolaryngologist or facial plastic surgeon may be warranted, though this is rarely needed for nondisplaced tip fractures. The conservative approach is preferred because the nasal bones have excellent blood supply and healing potential, and surgical intervention carries risks of anesthesia and potential cosmetic complications.
From the Research
Management of Acute Nondisplaced Fracture of Tip of Bilateral Nasal Bone
- The management of nasal fractures depends on whether the fracture is nondisplaced, displaced, open, or associated with a complication that necessitates a more aggressive approach 2.
- For acute nondisplaced fractures of the tip of bilateral nasal bone, closed reduction is often the preferred method of treatment, which is performed inside the nasal cavity without an incision 3.
- The use of prophylactic antibiotics in nasal bone fracture surgery is debated, with some studies suggesting that routine use is not recommended in uncomplicated cases 3, 4, 5.
- A retrospective study found that the antibiotic prescription rate was 67.3% among patients who underwent closed reduction of nasal bone fracture, but there were no cases of surgical site infection 3.
- Another study compared the results of patients who underwent closed reduction with or without prophylactic antibiotic administration and found that bacterial strain types cultured from packings were similar in both groups, and no patient showed signs of clinically significant infection 4.
- A prospective study of 30 cases also found that postoperative prophylactic antibiotic use is not clinically required after closed reduction of a nasal bone fracture 4.
- A retrospective cohort study found that prophylactic antibiotics do not decrease infection rates following nasal fractures managed by closed reduction 5.
- The literature describes early intervention (<14 days) with closed techniques as cost-effective, minimizing the need for possible secondary surgeries and improved early patient satisfaction, but delayed intervention (>3 months) with an open approach has many advantages over early closed technique 6.