Management of acute nasal fractures

In cases of facial trauma, nasal fractures account for approximately 40 percent of bone injuries. Treatment in the primary care setting begins with evaluating the injury, taking an accurate history of the situation in which the injury occurred, and ascertaining how the face and nose appeared and functioned before the injury occurred. Serious injuries should be treated, then nasal inspection and palpation may be performed to assess for airway patency, mucosal laceration, and septal deformity. A thorough examination of the nose and surrounding structures, including the orbits, mandible, and cervical spine, should be completed. Imaging studies are necessary for facial or mandibular fractures. Patients with septal hematomas, cerebrospinal fluid rhinorrhea, malocclusion, or extraocular movement defects should be referred to a subspecialist. Treatment in the primary care setting consists of evaluation, pain and infection management, minimal debridement and, when the physician is appropriately trained, closed reduction. If an immediate referral is not indicated, close follow-up, possibly with a subspecialist, should be arranged within three to five days after the injury.