Nasal fractures, occurring after either intentional or accidental trauma, are fairly common in clinical practice. Displacement of the nasal bone, epistaxis, local ecchymoses, edema, and tenderness are the main clinical features. The diagnosis relies on details obtained during history taking, findings from physical examination, and if necessary, imaging studies.
Nasal fractures are one of the most common forms of facial trauma in medical practice, with certain reports suggesting that they comprise up to 40% of all skeletal fractures   . They arise from trauma in virtually all cases, the most common form being a blunt trauma during contact sports  . In children, sports-related activities are the events leading to fracture, whereas motor vehicle accidents, falls, and intentional injuries, in addition to sports, are common causes in adults  . Many reports have confirmed that the peak incidence of nasal fractures is seen in adolescents around 20 years of age and that males suffer from nasal fractures much more frequently than women  . Depending on the mode of injury, patients present with a variable appearance of the nasal bone. It may be displaced outwardly after a lateral blow or depressed posteriorly after a direct blow to the nose . In some patients, however, the deformity might not be apparent . In addition to anatomical changes (nasal shortening, widening of the nasal base and malposition are also seen) epistaxis is the prominent symptom, indicating a more pronounced fracture   In addition, ecchymoses, local tenderness, edema, and crepitus are frequently noted   . In severe fracture, leakage of the cerebrospinal fluid (CSF), termed CSF rhinorrhea, changes in mental state, and limited movement of the eyes might be observed, in which case injuries of other anatomical structures should be excluded  . In fact, it is not uncommon for nasal fractures to be accompanied by additional maxillofacial or cervical injuries, especially in severe trauma .
Entire Body System
MAIN OUTCOME MEASURES: Pain scores and patient toleration of local or general nasal manipulation was noted. RESULTS: The pain score ranged from 0 (no pain) to 10 (unbearable pain). [ncbi.nlm.nih.gov]
A broken nose can cause pain, along with swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing. Treatment for a broken nose may include procedures that realign your nose. [mayoclinic.org]
Ease the Pain Take over-the-counter pain medicine as directed on the packagae (like acetaminophen or ibuprofen ) as needed. Sleep with your head propped on extra pillows. Reduce the Swelling Wrap an ice pack in a towel. [webmd.com]
Lacerations, ecchymosis (nasal and periorbital), septal deviation, and nasal obstruction may be present. Septal hematoma appears as a purplish bulge on the septum. [msdmanuals.com]
[…] facial fracture, third most common fracture of the body History and Exam: Usually preceding trauma (MVC, physical altercation, sports) +/- Epistaxis Nasal obstruction Swelling of nasal bridge Change in appearance, deviation Previous trauma Periorbital ecchymosis [medicine.uiowa.edu]
If ecchymosis (black and blue) is seen or if there is crepitus (“rice crackle” sounds) externally, a nasal fracture is suspected. The most definite way to diagnose a nasal fracture is by doing a nasal x-rays and studying the bones directly. [newyorkentspecialist.com]
- Saddle Nose
For nasal fracture presenting saddle nose deformity, the nasal septum was fixed with the frontal process of the maxillary bone by Kirschner wire. Good results were confirmed with computed tomography, and there was no secondary deformity. [ncbi.nlm.nih.gov]
The dead cartilage may disintegrate, causing the bridge of the nose to sag in the middle (called saddle nose deformity). Saddle Nose Deformity Saddle nose deformity occurs when cartilage in the nose dies and disintegrates. [msdmanuals.com]
Nasal septal cartilage necrosis can result in a saddle nose deformity with nasal obstruction. Nasal trauma can also result in a nasal fracture with resultant nasal obstruction and/or cosmetic deficits such as a saddle or crooked nose. [ttsh.com.sg]
Antibiotic prophylaxis for CSF rhinorrhea is controversial. Displaced fractures are usually managed by either immediate manual manipulation following the injury or once swelling has subsided at about 2 weeks after injury. [lifeinthefastlane.com]
Bedside glucose test strips do not accurately identify CSF rhinorrhea and are not recommended. [msdmanuals.com]
This may be caused by cerebrospinal fluid draining from the brain into the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on the nose or ears. Infection of the nose, sinuses, or facial bones. [uwhealth.org]
- Nasal Congestion
Skip to content Find Out More About Nasal Fracture A broken nose is a traumatizing and painful event that can lead to nasal congestion, a cosmetic problem, or both. [breatheclearinstitute.com]
] Symptoms include: blockage in breathing, change in nose shape, painful swelling of nasal septum and nasal congestion. Diagnosis Diagnosis can be made by a physical exam with the use of a nasal speculum or otoscope. [en.wikipedia.org]
People suffering from deviated nasal septum often complain about breathing obstruction, congestion, headaches and sinusitis troubles. [play.google.com]
Bleeding Nasal congestion but without any production of any drainage Bruising around the nose and eyes A grating sound with trying to move the nose. [epainassist.com]
Presentation This may present with [ 10, 11 ] : A nasal whistling sound. Discharge from the nose. Nasal congestion. Infection - eg, cellulitis, fever, discharge. Epistaxis. Aetiology Traumatic: Nose-picking. Trauma. [patient.info]
Such injuries may result in deformities affecting the outside and inside structures of the nose, which can cause problems breathing, sinus infections, nose bleeds, snoring, nasal obstruction and distorted facial features. [entaacare.com]
Some of the most common symptoms of a deviated nasal septum are blockages in either one or both nostrils, obstructed breathing, nasal congestions, chronic sinus, infections, bleeding of the nose, snoring, breathing through the mouth, headaches and facial [play.google.com]
हड्डी Allergy एलर्जी Phono-surgery Phono-सर्जरी Cleft Lip and Palate चीरा हुआ होंठ और तालु Endocrine surgery Endocrine सर्जरी Trauma आघात Skull base खोपड़ी का आधार Anterior skull base पूर्वकाल खोपड़ी का आधार Airway Airway Dizziness चक्कर आना Apnea and snoring [helpebookhindi.wikifoundry.com]
A further historical exploration of breathing difficulties, nasal congestion, snoring, sleep apnea, and nasal drainage will also allude to previous irregularities. [ncbi.nlm.nih.gov]
[…] s): location, magnitude, and direction of -nose before injury (appearance and function) -previous injuries to nose (30% of patients had pre-existing nasal deformities).........Photographs -focal symptoms: nasal obstruction, loss of smell (anosmia or hyposmia [ent.com.au]
Hyposmia 5. Watery rhinorrhoea 6. Visual disturbance 7. Diplopia 8. Epiphora 9. Altered bite 10. Loose teeth 11. Trismus. Examination Key issues to consider when examining a patient include: 1. Deviation, depression, step deformities 2. [slideshare.net]
Persistent anosmia or hyposmia may occur in as many as 5% of individuals who suffer head injury with or without nasal trauma and has been observed to resolve spontaneously in only a third of cases. 36 A review of a patient’s medical history includes any [clinicalgate.com]
In 20% the anosmia is unilateral, in the other cases, hyposmia is diagnosed. The prognosis of hyposmia is good, the one of anosmia is poor . Only 11.3% and 2.3% completely recover from anosmia and hyposmia, respectively. [doi.org]
[…] septal haematoma can develop into a septal abscess or lead to ischaemic necrosis of the septal cartilage in a delayed manner and subsequent saddle nose deformity. 12,13 Septal abscesses can result in meningitis, intracranial abscesses and cavernous sinus thrombosis [racgp.org.au]
[…] hearing. Visual symptoms and hearing loss may persist after an episode of meningitis. Inflammation of the brain (encephalitis) or its blood vessels (cerebral vasculitis), as well as the formation of blood clots in the veins (cerebral venous thrombosis [en.wikipedia.org]
Fractures that extend through the canal of the carotid artery may lead to pseudoaneurysm, dissection of the vascular wall, thrombosis with consecutive blindness or stroke, and carotid cavernous sinus fistulas , . [doi.org]
[…] for 40% of fractures resulting from facial trauma. [lifeinthefastlane.com]
Fracture nasal bones By Dr. T. Balasubramanian M.S. D.L.O. Synonyms: Fracture nasal bone, Broken nose, Nose fracture, Facial fracture. [drtbalu.co.in]
The nose is the most common facial bone to sustain a fracture. [entaacare.com]
Complete or partial loss of olfactory function may occur when the nasal passages are blocked, olfactory nerves are injured or there are contusions or hemorrhages in olfactory centers of the brain ( 4 ). [ispub.com]
Anatomical and functional outcomes in contusion injuries of posterior segment. Eye (Lond) 2011 Aug; 25 (8):1050–1056. doi: 10.1038/eye.2011.118. [ncbi.nlm.nih.gov]
[…] individuals' life can cause difficulty to go to work, attend school, or perform family responsibilities. Physical A number of physical injuries can commonly result from the blunt force trauma caused by a collision, ranging from bruising and contusions [en.wikipedia.org]
The reason may be the direct lesion of the olfactory bulb or the rupture of olfactory fibers at the cribriform plate, bleeding into the olfactory fibers, or contusion of the olfactory bulb and tract . [doi.org]
- Periorbital Ecchymosis
ecchymosis Palpation and direct visualization of nasal septum to rule out septal hematoma Helpful to see photo of patient prior to injury Does not require radiographic imaging. [medicine.uiowa.edu]
The presence of epistaxis, nasal swelling, and periorbital ecchymosis are signs that are suggestive of significant nasal trauma and warrant a thorough internal and external examination. [clinicalgate.com]
Physical examination findings include swelling over the nasal bridge, grossly apparent deviation of the nasal bones, and periorbital ecchymosis. [emedicine.medscape.com]
Face, Head & Neck
Topic Resources Fractures of the nasal bones or cartilaginous injury may result in swelling, point tenderness, hypermobility, crepitus, epistaxis, and periorbital bruising. Diagnosis is usually clinical. [msdmanuals.com]
Keywords: Internal carotid artery pseudoaneurysm, sphenoid sinuses trauma, massive epistaxis [orli.or.id]
Acute nasal injury often occurs as a result of trauma and can lead to epistaxis, nasal fracture, or even nasal septal haematoma. [bmj.com]
One of the most frequently used packing materials in closed reduction of a nasal bone fracture is the hydroxylated polyvinyl acetate sponge (PVAS; Merocel(®)); however this may cause synechia, epistaxis, and pain. [ncbi.nlm.nih.gov]
Epistaxis Epistaxis is common with nasal injuries caused by trauma to the nasal mucosa and vessels. To administer first aid, the nose should be held firmly with the thumb and forefinger, closing the nostrils. [racgp.org.au]
The diagnosis of a nasal fracture can be easily made with a proper clinical workup consisting of a detailed patient history and a physical examination. The exact mechanism of injury, including the direction, the intensity and circumstances under which it occurred, should be revealed during history taking, whereas a detailed inspection and palpation of the nose, but also the surrounding structures (the orbit, the mandible, the teeth, zygomatic arches and the cervical spine) are vital steps in recognizing the extent of trauma    . If an apparent displacement of the nose is evident during the exam, a definite diagnosis is made solely on clinical criteria, but in the setting of an apparently normal anatomical appearance, imaging studies are necessary to validate clinical suspicion   . Plain radiography is considered to be a useful initial method for the detection of nasal fractures, with very high rates of diagnoses . Certain reports, however, have established that ultrasonography (US), particularly high-resolution (HRUS), may be a superior method compared to X-rays in this particular setting   . Computed tomography (CT), a definite imaging procedure that can confirm the exact site of the fracture, but also identify additional head injuries, is not widely used due to its high radiation dose and exposure to the lens and the thyroid gland   . Despite the important role of imaging studies in the evaluation of nasal fractures, clinical awareness is pivotal in making an early diagnosis  .
Treatments are performed under quick IV sedation or general anesthesia on an outpatient basis. [entaacare.com]
Preferred Name Open treatment of nasal fracture; with concomitant open treatment of fractured septum Synonyms Open reduction of fracture of nasal bone with open repair of fracture of nasal septum ID http://purl.bioontology.org/ontology/CPT/21335 altLabel [bioportal.bioontology.org]
Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary for a broken nose. [mayoclinic.org]
[…] of an uncomplicated fracture of nasal bones is not urgent—a referral for specific treatment in five to seven days usually suffices—an associated injury, nasal septal hematoma, occurs in about 5% of cases and does require urgent treatment and should be [en.wikipedia.org]
Injuries involving other structures (Types 2 and 3) must be recognized and treated surgically. Prognosis Bone stability after a fracture occurs between 3 and 4 weeks. Full bone fusion occurs between 4 and 8 weeks. [en.wikipedia.org]
Plain radiograph sensitivity ~80% 6 best detected on the lateral view Waters view is useful in assessing the nasal arch 4 CT sensitivity is 100% 6 Treatment and prognosis Treatment depends on the degree of displacement. [radiopaedia.org]
Prognosis In most cases, the outlook is good, even when surgical treatment is necessary to realign or reconstruct the nose. [drugs.com]
Less common causes include falls and motor vehicle accidents. [7, 8] In a retrospective study, Erdmann et al investigated the medical records of 437 patients with 929 facial fractures.  These authors noted that the most common etiology of facial trauma [emedicine.medscape.com]
Abstract Nasal Bone Fracture: Etiology, Diagnostics, Treatment and Complications Background: The aim of the present evaluation was to analyse a large patient population with nasal bone fractures leading to surgical reposition of the nasal bone. [thieme-connect.com]
"Nasal bone fracture: etiology, diagnostics, treatment and complications". Laryngorhinootologie. 88 (11): 711–6. ^ Sethi, Neeraj; Pearson, Amy; Bajaj, Yogesh (2016). Key Clinical Topics in Otolaryngology. 191: JP Medical Ltd. ISBN 9781909836358. [en.wikipedia.org]
Etiology and chaging patterns of maxillofacial trauma. In: Boothb PW, Dchendel SA, Hausamen JE. Maxillofacial surgery. Ed 2. St. Louis: Churchill Livingstone Elsevier; 2007. H. 3. Ellis E, El-Attar A, Moos KF. [jurnal.ugm.ac.id]
Detailed knowledge of the epidemiology and diagnostic and therapeutic methods becomes imperative for the effectiveness of patient care. [scielo.br]
EPIDEMIOLOGY -of maxillofacial fractures, nasal fractures constituted 39%. - males in favor by 2 to 1 and higher incidence 15- to 30-year age group PATHOGENESIS -nasoethmoidal complex has a maximum tolerable impact force before fracture of 35 to 80g. [ent.com.au]
Is there a change in the epidemiology of nasal fractures in females in the UK? J Laryngol Otol 2013 ; 127 : 1084 -7. ↵ Joshi H, McPartlin D. Management of nasal fractures in a rural district general hospital: a completed loop. [bmj.com]
Epidemiology of US high school sports-related fractures, 2005-2009. Clin J Sport Med. 2010 Jul. 20(4):293-9. [Medline]. Hanba C, Svider PF, Chen FS, Carron MA, Folbe AJ, Eloy JA, et al. Race and Sex Differences in Adult Facial Fracture Risk. [emedicine.medscape.com]
In addition to an overall review of maxillofacial trauma pathophysiology, associated injuries, and physical examination, this review will also discuss relevant imaging, treatment, and disposition plans. [ncbi.nlm.nih.gov]
Pathophysiology: 1. Nasal bones and underlying cartilage are susceptible for fracture because of their more prominent and central position in the face. 2. These structures are also pretty brittle and poorly withstands force of impact. 3. [drtbalu.co.in]
PATHOPHYSIOLOGY 1. Nasal bones and underlying cartilage are susceptible for fracture because of their more prominent and central position in the face. 2. These structures are also pretty brittle and poorly withstands force of impact. 3. [slideshare.net]
Pathophysiology of post-traumatic anosmia. Laryngorhinootologie. 1996 Mar;75(3):154-9. [Article in German] 6. Sumner D. Post-traumatic anosmia. Brain 1964; 87:107–120. 7. Zusho H. Posttraumatic anosmia. Arch Otolaryngol 1982;108: 90–92 8. [ispub.com]
Pathophysiology If the primary buttresses of the nasoorbitoethmoid (NOE) complex are violated, comminution of the entire complex may occur. This may result in telecanthus, enophthalmos, diplopia, and apparent midface retrusion. [emedicine.medscape.com]
Prevention You can help prevent a nose fracture with these guidelines: Wear your seat belt when traveling in a motorized vehicle, and keep children restrained in age-appropriate child safety seats. [mayoclinic.org]
Prevention CDC Fall Prevention Activities US Centers for Disease Control and Prevention Preventing Falls: What Works―A CDC Compendium of Effective Community-based Interventions from Around the World US Centers for Disease Control and Prevention (PDF) [en.wikipedia.org]
Treatments are conservative to prevent damage to growth plates of the cartilage and bone. Severe deformities are conservatively reduced nonetheless to encourage straight growth of the septum and nose during growth spurts. [entaacare.com]
With this method, the occurrence of unnecessary new fractures can be prevented, in addition to minimizing the degree of mucosal damage and the occurrence of nasal hemorrhage. [ncbi.nlm.nih.gov]
- Kucik CJ, Clenney T, Phelan J. Management of acute nasal fractures. Am Fam Physician. 2004;70(7):1315-1320.
- Pérez-Guisado J. Clinical Evaluation of the Nose: A Cheap and Effective Tool for the Nasal Fracture Diagnosis. Eplasty. 2012;12:e3.
- Reilly MJ, Davison SP. Open vs closed approach to the nasal pyramid for fracture reduction. Arch Facial Plast Surg. 2007;9(2):82-86.
- Kelley BP, Downey CR, Stal S. Evaluation and Reduction of Nasal Trauma. Semin Plast Surg. 2010;24(4):339-347.
- Çil Y, Kahraman E. An analysis of 45 patients with pure nasal fractures. Ulus Travma Acil Cerrahi Derg. 2013;19(2):152-156.
- Javadrashid R, Khatoonabad M, Shams N, Esmaeili F, Jabbari Khamnei H. Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures. Dentomaxillofac Radiol. 2011;40(8):486-491.
- Mohammadi A, Ghasemi-Rad M. Nasal bone fracture--ultrasonography or computed tomography? Med Ultrason. 2011;13(4):292-295.
- Gürkov R, Clevert D, Krause E. Sonography versus plain x-rays in diagnosis of nasal fractures. Am J Rhinol. 2008;22:613–616.