From the Guidelines
A comminuted nasal fracture requires prompt evaluation and treatment to prevent permanent nasal deformity, breathing difficulties, or septal perforation, with initial management including ice application, pain control, and nasal decongestants, followed by closed or open reduction and internal fixation as needed. The treatment approach depends on the severity of the fracture and associated symptoms. For mild to moderate comminuted nasal fractures, initial management includes:
- Ice application for 15-20 minutes every 1-2 hours for the first 48-72 hours to reduce swelling
- Pain control using acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated, as recommended by 1
- Nasal decongestants such as oxymetazoline nasal spray twice daily for no more than 3 days to help reduce congestion
Closed reduction should be performed within 7-10 days of injury once swelling subsides, typically under local anesthesia, as suggested by 1. More complex comminuted fractures may require open reduction and internal fixation by a facial surgeon or otolaryngologist. Following reduction, a nasal splint is typically worn for 7-10 days for stabilization. Patients should avoid strenuous activity, nose blowing, and contact sports for at least 2-3 weeks. The use of camouflaging techniques, such as onlay grafts, may also be considered to improve the aesthetic appearance of the nose, as discussed in 1 and 1.
The goal of treatment is to restore the normal anatomy and function of the nose, while also improving the patient's quality of life by reducing symptoms and improving breathing and appearance. By prioritizing prompt evaluation and treatment, patients with comminuted nasal fractures can achieve optimal outcomes and minimize the risk of long-term complications.
From the Research
Definition and Diagnosis of Nasal Fractures
- Nasal fractures are the most commonly fractured bones in the body 2
- Accurate diagnosis and appropriate surgical intervention are key in the management of nasal fractures 2
- A thorough history and careful physical examination are adequate for the diagnosis of nasal fractures, and literature does not support the use of x-ray films to aid in the diagnosis 2
Treatment of Nasal Fractures
- The majority of nasal fractures should be definitively treated after 3 to 10 days once swelling has resolved, with the exception of grossly displaced fractures, open fractures, and septal hematomas 2
- Closed reduction is the most common method for treating nasal bone fractures, which is performed inside the nasal cavity without an incision 3
Use of Antibiotics in Nasal Fracture Treatment
- The routine use of perioperative antibiotics is not recommended in uncomplicated nasal bone fracture surgery 3, 4, 5
- Prophylactic antibiotic administration after surgery for a nasal bone fracture does not decrease infection rates following nasal fractures managed by closed reduction 5
- The non-use of postoperative antibiotics is biologically beneficial, as it reduces the occurrence of resistant strains and medical costs, and is more convenient for patients 4
Comminuted Nasal Fracture
- There is limited information available on comminuted nasal fractures in the provided studies
- However, it can be inferred that the treatment of comminuted nasal fractures would depend on the severity of the fracture and the presence of any complications, such as open fractures or septal hematomas 2, 6