Medical Terminology for Non-Fractured Nose Injuries
A nose injury without a fracture is termed "nasal soft tissue trauma" or "nasal contusion," which encompasses injuries to the skin, mucosa, and cartilage without bony disruption. 1
Classification of Non-Fractured Nasal Injuries
Non-fractured nasal injuries fall into several categories:
- Nasal contusion: Blunt trauma causing bruising and swelling of nasal soft tissues without bone or cartilage disruption 1
- Nasal soft tissue trauma: Encompasses lacerations, abrasions, and contusions affecting the external nasal skin and underlying soft tissues 1
- Nasal avulsion injuries: Range from minor skin loss to more extensive soft tissue damage without necessarily involving the bony framework 2
Critical Assessment Points
When evaluating any nasal trauma, even without obvious fracture, you must systematically exclude life-threatening and time-sensitive complications:
- Rule out septal hematoma immediately - this requires urgent drainage within 24-48 hours to prevent septal necrosis and permanent deformity 3, 4
- Assess airway patency - check for compromise from hemorrhage, soft-tissue edema, or loss of facial architecture 5
- Evaluate for epistaxis - control with well-aimed direct pressure for 10-15 minutes 6
- Screen for associated injuries - 68% of maxillofacial trauma patients have associated head injury, requiring evaluation for intracranial injuries, other facial fractures, and cervical spine injuries 5, 3
When Imaging Is NOT Needed
For isolated soft tissue nasal trauma without the following red flags, imaging is typically unnecessary:
- Plain radiographs have no role - they have only 53-82% accuracy and rarely alter management decisions for nasal injuries 5, 7
- CT is reserved for specific indications: visible or palpable nasal deformity, suspected complex injuries, associated facial fractures, or deep lacerations with exposed cartilage 7
- X-rays are not helpful for assessment of traumatic nasal injuries 4
Management of Soft Tissue Nasal Trauma
Conservative management is appropriate for soft tissue injuries without fracture or functional impairment:
- Prophylactic antibiotics are indicated for deep lacerations with exposed cartilage to prevent infection 5
- Nasal saline irrigation keeps nasal passages clean and prevents crusting 5
- Monitor for delayed complications including nasal airway obstruction from mucosal edema 5
- Immediate reconstruction is ideal when medically possible to decrease long-term sequelae and achieve both functional and cosmetic restoration 1
Common Pitfalls to Avoid
The most critical error is missing a septal hematoma, which appears as a boggy, fluctuant swelling of the nasal septum and requires urgent drainage 3, 4. Without treatment, this leads to septal necrosis, saddle nose deformity, and permanent functional impairment.