What is the treatment for a nasal bone fracture?

Treatment of Nasal Bone Fractures

Patients with nasal fractures should be referred to an otolaryngologist or plastic surgeon for definitive management, with early intervention (within 1-2 weeks) being critical for optimal outcomes. 1

Initial Assessment and Triage

• Clinical examination should include:

  • Assessment for external deformity
  • Nasal airway patency
  • Point tenderness
  • Mobility/crepitus of facial bones
  • Evaluation for septal hematoma or deviation 1

• Immediate intervention required for:

  • Septal hematoma (requires immediate drainage)
  • Signs of orbital or neurological complications
  • CSF rhinorrhea
  • Malocclusion
  • Extraocular movement defects 2

Diagnostic Imaging

• Preferred imaging modality:
  • Maxillofacial CT for complex fractures or when other facial bone involvement is suspected
  • Ultrasound is excellent for isolated nasal fractures (90-100% sensitivity, 98-100% specificity) 1
  • Plain radiographs have limited diagnostic value (53-82% accuracy) and rarely alter management 1

Specialist Referral Decision

• Refer to otolaryngologist when:

  • Nasal airway obstruction is present
  • Functional breathing concerns exist
  • Septal involvement is noted
  • Sinus involvement evaluation is needed 1

• Refer to plastic surgeon when:

  • Primary cosmetic concerns exist
  • Complex facial trauma involving multiple facial bones is present
  • Cosmetic outcome is the primary concern 1

• Pediatric cases:

  • Refer to pediatric otolaryngologist, especially for infants and children with congenital malformations 1
  • Consider child abuse in children younger than 5 years with inconsistent history 1

Treatment Approaches

Closed Reduction

• Appropriate for simple displaced fractures
• Often performed under local anesthesia in outpatient setting
• Should be performed within 1-2 weeks of injury for optimal results 1

Open Reduction

• Indicated for:
  • Complex fractures
  • Significant septal involvement
  • Failed closed reduction
  • Delayed presentation (>2 weeks) 1

Septal Management

• Critical component of successful nasal fracture management
• 96.2% of simple nasal bone fractures involve septal fractures 3
• Septoplasty or submucosal resection may be required in severe septal fractures 3

Common Pitfalls and Caveats

1. Overlooking septal involvement: Septal fractures are present in over 96% of nasal bone fractures and require appropriate management to prevent long-term functional issues 3

2. Delayed referral: Waiting beyond 1-2 weeks significantly reduces the success rate of closed reduction and increases the need for more complex procedures 1

3. Inadequate imaging: While physical examination is crucial, appropriate imaging helps identify complex fractures and associated injuries 1

4. Missing associated injuries: Nasal fractures may be part of more extensive facial trauma requiring comprehensive evaluation 1

5. Failure to recognize pediatric considerations: Children require specialized management approaches and consideration of potential abuse in certain circumstances 4

By following this structured approach to nasal fracture management, clinicians can optimize both functional and cosmetic outcomes while minimizing the need for secondary corrective procedures.