How to manage a nasal fracture or deviation?

From the Guidelines

Management of a nasal fracture or deviation requires prompt medical attention, ideally within 3-5 days of injury, and may involve closed reduction, septoplasty, or rhinoplasty procedures to improve breathing and cosmetic appearance. For immediate care, apply ice packs for 15-20 minutes every 1-2 hours during the first 48 hours to reduce swelling, and take acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for pain relief, as suggested by general medical guidelines 1.

When considering surgical intervention, the goal is to restore normal nasal function and appearance. Septoplasty, which reshapes, repositions, or recontours the cartilage, is a commonly used procedure, with as many as 77% of patients achieving subjective improvement 1. Endoscopic septoplasty is replacing traditional septoplasty in many clinical settings, offering a less invasive alternative 1. For cases with turbinate hypertrophy, inferior turbinate reduction surgery may be performed concurrently with septoplasty, although the long-term benefits of this approach are still being studied 1.

In terms of specific surgical techniques, the choice of procedure depends on the type and severity of the septal deviation. For bony hypertrophy, options include turbinectomy, turbino-plasty, and submucosal resection, each with its own advantages and potential complications 1. Powered microdebrider-assisted inferior turbinoplasty is a relatively new procedure that can be conducted in the office setting under local anesthesia and has shown promising results with minimal bleeding and crusting 1.

For nasal bone deviations, osteotomies may be necessary to reposition the nasal bones and achieve a more symmetrical shape. The configuration of lateral osteotomies should be tailored to the patient's anatomy, and the sequence of osteotomies may vary depending on the presence of a nasal dorsal hump or the severity of the deviation 1.

Key considerations in the management of nasal fractures and deviations include:

• Prompt medical attention to prevent long-term complications
• Accurate diagnosis of the type and severity of the fracture or deviation
• Selection of the most appropriate surgical procedure based on the individual patient's needs
• Careful postoperative care to ensure proper healing and minimize the risk of complications
• Follow-up appointments to monitor healing and make any necessary adjustments to the treatment plan.

From the Research

Management of Nasal Fracture or Deviation

To manage a nasal fracture or deviation, several factors need to be considered, including the timing of treatment, the choice between closed or open reduction, and how to manage subsequent revision surgeries if necessary 2.

Acute Management

In the acute setting, optimal management of nasal trauma is critical in minimizing secondary nasal deformities 3. Early intervention with closed techniques can be cost-effective and improve early patient satisfaction, but may result in a high rate of subsequent open treatment, particularly where there is significant septal involvement in the fracture 4.

Treatment Options

Treatment options for nasal fractures include:

• Closed reduction: This method tends to decrease postoperative septal deviation in all fracture types, but the values are significantly meaningful only in certain fracture types 5.
• Open reduction: Delayed intervention with an open approach has many advantages over early closed technique, including lower revision rate, improved ability for rigid fixation and support, and the ability to correct severe dorsal or caudal L-strut deformities, nasal valve issues, and severe nasal bony deviation/deformities 4.
• Conservative management: This approach may be considered for patients who are reluctant to undergo closed reduction, but physicians should address the possible outcomes and prognosis of untreated nasal bone fractures 5.

Considerations

When managing nasal fractures, several considerations need to be taken into account, including:

• The degree of septal deviation: This can be calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images 5.
• The type of fracture: Different fracture types may require different treatment approaches 5.
• The patient's demographics: Nasal fracture management and subsequent surgical outcomes can vary across demographics 2.
• The potential complications: Nasal bone fractures can pose significant long-term challenges if not diagnosed and treated correctly, including septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and mental health issues 2.