From the Guidelines
A nondisplaced nose fracture typically requires conservative management, with imaging via CT Maxillofacial being useful in diagnosing and characterizing the extent of injuries, particularly for complex nasal injuries and associated facial fractures. The management of a nondisplaced nose fracture involves rest, ice application for 15-20 minutes every 1-2 hours for the first 48 hours, elevation of the head while sleeping, and over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) as recommended 1. It is essential to avoid aspirin due to the risk of bleeding. Applying gentle pressure to control any nosebleeds by pinching the soft part of the nose for 10-15 minutes is also advised. Most nondisplaced fractures heal within 3-6 weeks without surgical intervention. However, if breathing difficulties persist or cosmetic concerns arise after swelling subsides (usually 5-7 days), it is crucial to consult an otolaryngologist or facial surgeon. Complications like septal hematoma require immediate medical attention as they can lead to cartilage necrosis.
The use of CT Maxillofacial in diagnosing maxillofacial injuries, including nondisplaced nose fractures, offers superb delineation of osseous and soft-tissue structures, allowing for the detection of subtle nondisplaced fractures of the facial skeleton 1. CT provides high image resolution with thin-section acquisitions and offers multiplanar and 3-D image reconstructions, which are critical in preoperative planning for complex fractures. In particular, many surgeons find the 3-D reformations afforded by CT to be essential in their preoperative planning 1.
Key considerations in the management of nondisplaced nose fractures include:
- Monitoring for signs of complications such as septal hematoma
- Avoiding activities that may exacerbate the injury
- Following up with a healthcare provider to assess the healing progress and address any concerns
- Considering surgical intervention if necessary, based on the severity of the fracture and the presence of any complications. CT with IV contrast does not aid in the detection of facial injury, and its use should be guided by the clinical suspicion of specific complications 1.
From the Research
Nondisplaced Nose Fracture
- A nondisplaced nose fracture is a type of nasal fracture where the bones are not significantly out of place 2.
- According to a 10-year cross-sectional cohort retrospective study, nondisplaced fractures accounted for 81.10% of all nasal bone fractures 2.
- The study found that men aged 20-29 years with no education were more likely to experience nondisplaced nasal fractures, often caused by interpersonal violence 2.
- Treatment for nondisplaced nose fractures often involves close nasal reduction (CNR) + closed septoplasty, which can help reduce the risk of postoperative complications 2.
- A study on the management of nasal fractures suggests that accurate diagnosis and appropriate surgical intervention are key in managing nasal fractures, including nondisplaced ones 3.
- Another study recommends that athletes with nondisplaced nasal fractures may return to play, but should wear a face mask for 6 weeks after the injury to prevent further complications 4.
Management and Treatment
- The management of nondisplaced nose fractures typically involves a thorough history and careful physical examination, without the need for x-ray films 3.
- Treatment should be deferred until 3 to 10 days after the injury, once swelling has resolved, unless there are complications such as airway compromise or septal hematoma 3, 4.
- A study on the acute, subacute, and delayed management of nasal fractures suggests that early intervention with closed techniques can be cost-effective, but may result in a high rate of subsequent open treatment 5.
- The use of prophylactic antibiotics in the treatment of nondisplaced nose fractures is not recommended, unless there are complications or comorbidities that increase the risk of infection 6.