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 [1] [2] [3]. They arise from trauma in virtually all cases, the most common form being a blunt trauma during contact sports [1] [4]. 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 [1] [3]. 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 [4] [5]. 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 [1]. In some patients, however, the deformity might not be apparent [1]. 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 [1] [4] In addition, ecchymoses, local tenderness, edema, and crepitus are frequently noted [1] [2] [4]. 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 [1] [4]. In fact, it is not uncommon for nasal fractures to be accompanied by additional maxillofacial or cervical injuries, especially in severe trauma [1].

• Hypoxemia

  The situation is quite different when the loss of vision is delayed: if the swelling of the nerve leads to hypoxemia, an intervention seems to be promising [263]. [doi.org]

• 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]

  Though uncommon, a septal hematoma can lead to complications such as septal abscess, septal perforation and cartilage necrosis with potential saddle nose deformity. [ttsh.com.sg]

• Rhinorrhea

  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. [wa.kaiserpermanente.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]

  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]

  congestion.[3] Diagnosis[edit] Diagnosis can be made by a physical exam with the use of a nasal speculum or otoscope. [en.wikipedia.org]

  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]

  Nasal congestion. Infection - eg, cellulitis, fever, discharge. Epistaxis. Aetiology Traumatic: Nose-picking. Trauma. Septal haematoma may cause infection and abscess formation ( which may lead to perforation) if not treated promptly. [patient.info]

• Hyposmia

  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]

  […] 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]

  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 [242]. Only 11.3% and 2.3% completely recover from anosmia and hyposmia, respectively. [doi.org]

• Snoring

  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]

• Difficulty Opening the Mouth

  Displacement, difficulty opening the mouth and double vision are associated with some fractures and require treatment. [entaacare.com]

• Fracture

  Nasal fracture Other names Broken nose Plain X-ray showing a nasal fracture Specialty Emergency medicine, otorhinolaryngology Symptoms Nose bleed, swelling, bruising[1][2] Complications Septal hematoma, other facial fractures, meningitis[1] Usual onset [en.wikipedia.org]

  […] for evaluating nasal fracture in children. [ncbi.nlm.nih.gov]

• Epistaxis

  Pain, bruising, epistaxis (nose bleeds), obstruction, change in shape may or may not be present. [rhinoplasty-blog.com]

  However, epistaxis without obvious nasal deformity may be the only clinical finding in some nasal fractures. [aafp.org]

  • Persistent bleeding through the nose (epistaxis) • Presence of a hole in the nasal septum that divides the nose. [medindia.net]

  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]

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 [1] [2] [4] [6]. 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 [1] [5] [6]. Plain radiography is considered to be a useful initial method for the detection of nasal fractures, with very high rates of diagnoses [5]. 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 [6] [7] [8]. 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 [1] [6] [7]. Despite the important role of imaging studies in the evaluation of nasal fractures, clinical awareness is pivotal in making an early diagnosis [1] [7].

• Ischemic Changes

  changes on the electrocardiogram after a general anesthesia. [ncbi.nlm.nih.gov]

• Electrocardiogram Change

  She underwent general anesthesia for the reduction of the fracture; after surgery, she developed acute chest pain, elevated cardiac biomarkers, ischemic electrocardiogram changes, and transient akinesis of the left ventricle without significant epicardial [ncbi.nlm.nih.gov]

1. Kucik CJ, Clenney T, Phelan J. Management of acute nasal fractures. Am Fam Physician. 2004;70(7):1315-1320.
2. Pérez-Guisado J. Clinical Evaluation of the Nose: A Cheap and Effective Tool for the Nasal Fracture Diagnosis. Eplasty. 2012;12:e3.
3. Reilly MJ, Davison SP. Open vs closed approach to the nasal pyramid for fracture reduction. Arch Facial Plast Surg. 2007;9(2):82-86.
4. Kelley BP, Downey CR, Stal S. Evaluation and Reduction of Nasal Trauma. Semin Plast Surg. 2010;24(4):339-347.
5. Çil Y, Kahraman E. An analysis of 45 patients with pure nasal fractures. Ulus Travma Acil Cerrahi Derg. 2013;19(2):152-156.
6. 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.
7. Mohammadi A, Ghasemi-Rad M. Nasal bone fracture--ultrasonography or computed tomography? Med Ultrason. 2011;13(4):292-295.
8. Gürkov R, Clevert D, Krause E. Sonography versus plain x-rays in diagnosis of nasal fractures. Am J Rhinol. 2008;22:613–616.