Because of its prominent position on the face, the nose is one of the most injured areas of the head and neck. Whether from sports injuries, falls, or altercations, nasal fractures are a condition that otolaryngologist see quite often.
The typical history of nasal trauma followed by nose bleeding and subsequent nasal obstruction, strongly suggests nasal fracture. Physical exam findings of significant structural derangement can be diagnostic. In many instances, the external nasal deformity is not quite so obvious. In those cases, an X-ray or CT of the nose is warranted to more precisely evaluate the integrity of the bony and cartilaginous nasal structures.
Treatment of nasal fractures depends upon the severity of the injury and the wishes of the patient. If there is an open nasal fracture, with exposed bone and soft tissue, an operation to cleanse the wound and repair the fractures and close the soft tissue is warranted immediately to avoid severe deformity and infection. Most nasal fractures are closed, however. In cases of obvious deformity, closed reduction of the nasal fracture and external splinting within 10 to 14 days of the injury is indicated. After two weeks, the bones will be set in the fractured position and closed reduction will be ineffective. In a few cases of closed fractures not set within that two week window the patient will be left with a permanent nasal deformity. If the appearance of the nose is unsatisfactory and/or there is nasal obstruction as a result of the fractures, then a delayed surgical approach may be considered. In these instances, the nasal bones will have to be re-broken in a controlled fashion in the operating room and placed back in their native position. External splinting and possibly internal splinting as well are frequently employed for a week after surgery to allow the bones to set and healing to begin.
Anyone who has nasal trauma that feels that they may have fractured the nose, should be evaluated as soon as possible to rule out septal hematoma. This is a collection of blood beneath the covering of the cartilaginous nasal septum. If this condition is left untreated, it can result in severe infection in the soft tissue of the nose and/or destruction of the cartilaginous septum, which may cause a saddle nose deformity. Rapid, accurate diagnosis of nasal fractures allows planning of appropriate treatment and avoidance of unwanted complications.