From the Guidelines
The management of a nasal bone fracture primarily involves assessment, reduction if needed, and appropriate follow-up care, with closed reduction typically performed within 3-10 days of injury under local or general anesthesia 1. The initial management includes controlling epistaxis with direct pressure, ice application, and head elevation. Patients should be evaluated for septal hematoma, which requires immediate drainage if present.
Key Considerations
- For displaced fractures, the procedure involves realigning the nasal bones using instruments such as Asch or Walsham forceps.
- Post-reduction, external nasal splinting is applied for 7-10 days to maintain alignment.
- Patients should receive appropriate analgesia, typically acetaminophen or NSAIDs, and may benefit from a short course of antibiotics if there are open wounds or significant mucosal damage.
- Nasal decongestants like oxymetazoline can help reduce swelling but should be limited to 3 days to prevent rebound congestion.
Follow-up and Potential Complications
- Follow-up evaluation at 1-2 weeks is recommended to assess healing and alignment.
- More complex fractures with significant septal involvement or those associated with other facial fractures may require open reduction and internal fixation by a specialist.
- Delayed complications like persistent deformity or nasal obstruction may necessitate rhinoplasty after complete healing, typically 3-6 months post-injury, as suggested by the principles outlined in the management of nasal bone fractures 1.
From the Research
Management of Nasal Bone Fracture
The management of nasal bone fractures involves various techniques and considerations to ensure proper healing and minimize complications.
- The most common method for treating nasal bone fracture is closed reduction, which is performed inside the nasal cavity without an incision 2.
- Closed reduction can be performed under general or local anesthesia, with or without the use of elevators or forceps 3.
- Manual reduction under local anesthesia using the little finger has been shown to be an effective and efficient procedure with high patient satisfaction and favorable postoperative functional and aesthetic outcomes 3.
- The use of prophylactic antibiotics in nasal bone fracture management is not recommended in uncomplicated cases, as it does not reduce the risk of surgical site infection and may be associated with infection-related complications 2.
Treatment Modalities
Different treatment modalities have been studied and compared in the management of nasal bone fractures.
- Serial nasal bone reduction has been shown to be effective in reducing the failure rate of nasal bone reduction 4.
- A comparative study of general, local, and topical anesthesia techniques for nasal bone fracture reduction found no significant difference in pain scores, patient satisfaction, and failure rates among the three groups 5.
- Topical anesthesia is suggested for simple nasal fractures with unilateral depression or minimal displacement 5.
Diagnostic Techniques and Timing of Treatment
- A thorough history and careful physical examination are adequate for the diagnosis of nasal fractures, and x-ray films are not necessary 6.
- Most nasal fractures should be definitively treated after 3 to 10 days once swelling has resolved, except for grossly displaced fractures, open fractures, and septal hematomas 6.