Fracture of nasal bones is the most common fracture of the facial skeleton and can be caused by traffic accidents, accidents at work, falls and many others. It is very important to recognise nasal fracture because reposition should be carried out within the first 24-48 hours to avoid edema, cosmetic and functional sequelae.
Fracture is suggested by septal deformation, external nasal deformity, crepitance or palpably mobile bony segments. Epistaxis and pain are common. Patients present with ecchymoses of the periorbital soft tissues (black eyes ), nasal obstruction is always present.
The history of nasal trauma and clinical manifestations make the diagnosis. Fractures of nasal bones can be associated with injury to other midfacial and paranasal sinus, ethmoid complex and frontal bone.It is important to make certain that there is no palpable step-off of the infraorbital rim, which would indicate the presence of a zygomatic complex fracture. Radiologic confirmation of nasal fracture may at times not be necessary in uncomplicated cases.
Anterior rhynoscopy must be done in all cases to rule out septal hematoma which needs drenage to avoid infection.
It is aimed at maintaining long-term nasal airway patency and nasal aesthetics.
Close reduction with local injected 1% lidocaine should be attempted within some days of injury. In the presence of marked nasal swelling it is best to wait several days for the edema to subside before undertaking reduction. Persistent functional or cosmetic defects may be repaired by delayed reconstructive nasal surgery.
Nasal trauma can cause some complications such as : septal hematoma, septal perforation, septal deformation and clear rhinorrhea as result of nasoethmoidal fracture.
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