How do you treat a fractured nose?

Management of Nasal Fractures

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

Initial Assessment and Management

• Clinical Examination:

  • Assess for external deformity, nasal airway patency, point tenderness
  • Check for mobility/crepitus of facial bones
  • Evaluate for septal hematoma or deviation (requires immediate evacuation if present) 1

• Immediate Management:

  • For epistaxis (nosebleed): Have patient sit with head slightly forward with nostrils pinched for 10-15 minutes 2
  • Seek immediate medical attention if bleeding doesn't stop after 15 minutes, patient becomes lightheaded, or there are signs of brain injury, obvious nasal deformity, or facial fracture 2
  • Immediately drain any septal hematoma to prevent complications 1

Diagnostic Imaging

• Preferred Imaging:
  • Maxillofacial CT for complex facial fractures or suspected additional injuries
  • Ultrasound is excellent for isolated nasal fractures (90-100% sensitivity, 98-100% specificity) and avoids radiation 1
  • Plain radiographs have limited diagnostic value (53-82% accuracy) 1

Treatment Approaches

Closed Reduction

• First-line treatment for simple nasal fractures 3
• Performed under local anesthesia in outpatient setting
• Best performed within 1-2 weeks of injury 1

Open Reduction

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

Specialized Techniques for Cartilaginous Injuries

• Mobilization
• Trimming/thinning
• "Contralateral subluxation locking"
• Reconstruction with "figure 8" sutures and batten grafts 1

Specialist Selection

• Otolaryngologist: Preferred for cases with nasal airway obstruction, functional breathing concerns, septal involvement, or sinus involvement 1

• Plastic Surgeon: Preferred for primary cosmetic concerns, complex facial trauma involving multiple facial bones 1

• Pediatric Otolaryngologist: Recommended for infants and children, especially those with congenital malformations 1

Special Considerations

• Septal Injuries: Should be recognized and properly treated to prevent post-reduction deformity and obstruction 4

• Timing: Early intervention (within 1-2 weeks) is critical for optimal outcomes 1

• Pediatric Cases: Consider child abuse as a possible cause in children under 5 years with inconsistent history or injuries incompatible with reported mechanism 1

• Associated Injuries: Nasal fractures may be part of more extensive facial trauma requiring comprehensive evaluation 1

Potential Complications

• Persistent nasal deformity
• Nasal airway obstruction
• Breathing difficulties
• Septal perforation
• Long-term functional and cosmetic complications 1

Follow-up

• Regular follow-up with specialist to monitor healing and address any developing complications
• Secondary procedures may be necessary if initial reduction fails to achieve desired functional or cosmetic outcomes