Management and Referral for Nasal Fractures
Patients with nasal fractures should be referred to an otolaryngologist or plastic surgeon within 1-2 weeks of injury for optimal functional and cosmetic outcomes, with immediate referral indicated for cases with septal hematoma, significant displacement, or associated injuries. 1
Initial Assessment and Imaging
Clinical Evaluation
- Assess for:
- External nasal deformity
- Nasal airway patency
- Point tenderness
- Mobility/crepitus of facial bones
- Septal hematoma or deviation (requires immediate evacuation if present)
- Signs of associated facial fractures
Diagnostic Imaging
- CT maxillofacial is the gold standard for diagnosing nasal fractures, offering superior delineation of osseous and soft-tissue structures 1
- Ultrasound is an excellent radiation-free alternative with 90-100% sensitivity for isolated nasal fractures 1
- Plain radiographs have limited diagnostic value (53-82% accuracy) and rarely alter management 1
Referral Criteria
Immediate Referral (Emergency)
- Presence of septal hematoma (requires immediate drainage)
- Signs of orbital or neurological complications 2:
- Periorbital edema/erythema
- Displaced globe
- Double vision
- Ophthalmoplegia
- Reduced visual acuity
- Severe frontal headache
- Neurological signs
Urgent Referral (Within 1-2 weeks)
- Displaced/depressed nasal fractures
- Complex nasal injuries
- Unstable or "flail" nasal fractures
- Significant soft tissue edema 1
Management Approach
Timing of Intervention
- Early intervention (within 1-2 weeks) is critical for optimal outcomes 1
- Intervention beyond 4 weeks significantly reduces the success rate of closed reduction
Treatment Options
Closed Reduction
- Appropriate for simple displaced fractures
- Often performed under local anesthesia in outpatient setting
- Best results when performed within 2 weeks of injury
Open Reduction
- Indicated for complex fractures or significant septal involvement
- Required for fractures that cannot be adequately reduced with closed techniques
- May involve specialized techniques for cartilaginous injuries 1
Potential Complications
Without appropriate specialist consultation and treatment, patients may experience:
- Persistent nasal deformity
- Nasal airway obstruction
- Breathing difficulties
- Septal perforation
- Long-term functional and cosmetic complications 1
Special Considerations
- Associated Injuries: Nasal fractures may be part of more extensive facial trauma requiring comprehensive evaluation
- Pediatric Patients: Consider child abuse in children younger than 5 years with inconsistent history or injuries incompatible with reported mechanism 1
- Frontal Bone Injuries: Often associated with nasal fractures and may require additional imaging and management 2
Follow-up Care
- Follow-up with the specialist is essential to monitor healing and address any developing complications
- Secondary rhinoplasty may be necessary for persistent deformities after initial treatment
- The goal of treatment is to restore both function and cosmesis 3