From the Guidelines
To manage your nasal fracture, it is crucial to avoid strenuous activities, bending, and heavy lifting, and to keep your head elevated while sleeping, as these measures can help reduce the risk of further bleeding and promote healing. When it comes to pain management, acetaminophen (Tylenol) is recommended as it does not increase the risk of bleeding, unlike aspirin and ibuprofen 1.
Key Instructions for Nasal Fracture Management:
- Apply ice packs to your nose for 15-20 minutes every 1-2 hours for the first 48 hours to reduce swelling and pain.
- Avoid blowing your nose for at least 48 hours, and if you need to sneeze, do so with your mouth open to reduce pressure on your nasal passages.
- Avoid wearing glasses that rest on your nose bridge for 4 weeks; consider using contact lenses if possible.
- If nasal packing is in place, keep the nose and packing moist with nasal saline sprays throughout the day to reduce crusting and help resorbable packing melt away 1.
- Be aware of symptoms that require immediate medical attention, such as increased bleeding that doesn't stop after 10 minutes of gentle pressure, severe pain not controlled by medication, fever above 101°F, increasing swelling after 3 days, difficulty breathing through your nose that worsens, or clear fluid draining from your nose.
Follow-Up Care:
It is essential to follow up with an ENT specialist or facial surgeon in 5-7 days as recommended to evaluate if surgical repair is needed. Most nasal fractures heal well with conservative management, but proper follow-up ensures optimal cosmetic and functional outcomes. Strict adherence to follow-up instructions will allow for appropriate removal of packing when necessary and should make complications less frequent 1.
From the FDA Drug Label
Directions: Adults and children 6 to under 12 years of age (with adult supervision): 2 or 3 sprays in each nostrill not more often than every 10 to 12 hours. Do not exceed 2 doses in any 24-hour period. Children under six years of age: ask a doctor. To spray, squeeze bottle quickly and firmly. Do not tilt head backward while spraying. Wipe nozzle clean after use.
For a patient with a nasal fracture, the following ED discharge instructions can be provided:
- Use oxymetazoline (IN) as directed: 2 or 3 sprays in each nostril, not more often than every 10 to 12 hours, and do not exceed 2 doses in any 24-hour period 2.
- Follow proper spraying technique: squeeze bottle quickly and firmly, and do not tilt head backward while spraying.
- Clean the nozzle after use to prevent infection.
- For children under 6 years, consult a doctor for guidance on use 2.
From the Research
ED Discharge Instructions for Nasal Fracture
- Follow-up care:
- Wound care:
- Keep the nasal area clean and dry
- Avoid blowing your nose for at least 2-3 weeks
- Pain management:
- Use pain medication as directed by your doctor
- Activity level:
- Avoid strenuous activities, such as heavy lifting or bending, for at least 2-3 weeks
- Antibiotics:
- Prophylactic antibiotics may not be necessary, as they do not decrease infection rates following nasal fractures managed by closed reduction 5
- Complications:
- Watch for signs of infection, such as increased redness, swelling, or discharge
- Seek medical attention immediately if you experience any of these symptoms
- Additional tips:
- Use saline nasal sprays to help keep the nasal passages moist
- Avoid smoking, as it can delay healing and increase the risk of complications
- Consider delayed intervention (>3 months) with an open approach, which may have advantages over early closed technique, including lower revision rate and improved ability for rigid fixation and support 6