Management of nasal bone fractures

This review discusses treatment options for nasal fracture, a common condition due mainly to road accidents, sport injuries, and physical confrontations. Being frequently associated with multiple trauma, many broken noses are not promptly diagnosed and treated, leading to secondary nasal deformities and chronic obstructions. A description of nasal anatomy is followed by considerations on the pathogenesis of nasal fracture and its clinical assessment. Each patient's history must be recorded (cause of trauma, previous facial injuries, prior nasal deformity, or obstruction) and careful physical examination guides the choice of treatment (open vs closed reduction), its timing, and the type of anesthesia required. Adequate follow-up is essential. Manipulation under local anesthesia is an effective first-line treatment for simple nasal fractures and should become a standard practice, but any associated septal injury can be responsible for postoperative nasal deformity and obstruction so other options may need to be considered.