Broken Nose

Question 1

structure of the nose

Answer 1

top 1/3rd bony

other 2/3rds cartilaginous

Question 2

define a septal haematoma

Answer 2

blood filling under the perichondrium, if this occurs on both sides of the nose it can cause cartilage death. This is because the cartilage is avascular and requires nutrients and oxygen from the perichondrium. This causes loss of nose shape/collapse and on palpation it is boggy

Question 3

assessment of a broken nose

Answer 3

check nasal air flow

review in ENT clinic 5-7 days post-injury due to swelling

Question 4

management

Answer 4

consider digital manipulation if under 3 weeks old, otherwise rhinoplasty

Question 5

complications of a broken nose

Answer 5

septal haematoma
epistaxis
CSF leak and meningitis
anosmia

Question 6

most common artery to cause epistaxis

Answer 6

anterior ethmoid artery

Question 7

hippocratic management of a broken nose

Answer 7

external pressure to the cartilaginous portion for 15-20 minutes (if bleeding does not stop then go to hospital), ice, cautery and nasal packing

Question 8

hospital management of broken nose in acute epistaxis setting

Answer 8

topical vasoconstrictor +/- LA (lignocaine and adrenaline +/- co-phenylcaine), remove clot (suction or blowing nose), cauterise vessel (silver nitrate and diathermy)

Question 9

which vessels are normally cauterised?

Answer 9

sphenopalatine artery
anterior ethmoidal artery
unusually ECA

Question 10

systemic management of a broken nose epistaxis

Answer 10

reversal of anticoagulants (takes longer if antiplatelet)
platelet transfusion
manage hypertension

Question 11

what causes anosmia in a broken nose?

Answer 11

cribriform plate fracture