From the Guidelines
To assess for a possible broken nose, a thorough physical examination should be performed, including inspection for visible deformity, swelling, bruising, or bleeding, and gentle palpation to check for tenderness, instability, or unusual movement, with imaging tests like CT scans reserved for cases where the diagnosis is uncertain or the injury is severe, as recommended by the most recent study 1. When assessing for a possible broken nose, several key signs and symptoms should be evaluated, including:
- Visible deformity, swelling, bruising, or bleeding around the nose
- Tenderness, instability, or unusual movement upon gentle palpation
- Crunching sounds (crepitus) when touching the nose
- Breathing difficulties through the nostrils
- Deviation of the nasal septum or presence of a septal hematoma
- Black eyes (periorbital ecchymosis), nosebleeds, and facial numbness If pain is severe, acetaminophen (Tylenol) 325-650 mg every 4-6 hours as needed, not exceeding 3000 mg daily, can be taken, and ice wrapped in a cloth can be applied for 15-20 minutes every 1-2 hours for the first 48 hours to reduce swelling. According to the American College of Radiology, CT scans are useful in diagnosing maxillofacial injuries, including nasal fractures, and offer superb delineation of osseous and soft-tissue structures, with high image resolution and multiplanar and 3-D image reconstructions, as noted in the study 1. However, ultrasound (US) has been shown to be a reliable diagnostic tool for estimating the time of nasal bone fracture, with high sensitivity and specificity, and may be useful in certain cases, particularly for isolated nasal bone fractures, as reported in the study 1. It is essential to seek medical attention if there's significant deformity, breathing difficulty, severe pain, clear fluid draining from the nose (possible cerebrospinal fluid leak), or if the injury resulted from substantial trauma, as prompt assessment and treatment can help prevent complications such as breathing problems, cosmetic issues, or septal hematomas that may cause permanent nasal deformity if not drained.
From the Research
Assessing for a Possible Broken Nose
To assess for a possible broken nose, the following steps can be taken:
- Record the patient's history, including the cause of trauma, previous facial injuries, prior nasal deformity, or obstruction 2
- Perform a careful physical examination to guide the choice of treatment 2
- Use anterior rhinoscopy as part of the exam to assess for nasal function 3
- Consider using a patient questionnaire to assess function, followed by other methods such as response to decongestant spray, nasal endoscopy, computed tomography scan, rhinomanometry, acoustic rhinometry, Cottle maneuver, and response to nasal strips 3
- Take photographs and document the examination for future reference and to create a reconstruction plan if necessary 4
Examination Techniques
The examination of the nose can be challenging due to its anatomy, but advances in medical technology have improved the instrumentation and techniques used 5. The following techniques can be used:
- Inspection: a comprehensive visual assessment 6
- Palpation: using touch to gather information 6
- Percussion: striking the chest to determine the state of underlying tissues 6
- Auscultation: listening to and interpreting sound transmission through the chest wall via a stethoscope 6
Importance of Accurate Assessment
Accurate assessment and documentation of nasal trauma are crucial for proper management and treatment 4. A thorough examination and documentation can help identify underlying damage to cartilage or bone and guide the reconstruction plan.