Fractured Nose

Question 1

What are the important point to elicit from a history of trauma to the nose

Answer 1

Time of injury
any LOC
CSF or rhinorrhoea
Epistaxis
Previous nose injuries
Symptoms of obstruction

Question 2

What are the signs of an orbital floor blowout

Answer 2

Diplopia (double)
Restricted eye movements
Ophthalmoplegia: typically up and down
Globe displacement
Severe: enophthalmos
Periorbital ecchymosis, oedema
Subcutaneous emphysema
Teeth malocclusion

Question 3

Management for fractured nose

Answer 3

Clinical diagnosis (cartilaginous injuries won’t show up and radiographs will not alter management)

Immediate, before swelling → reduce immediately
Swelling → re-examine after 1 week (↓ swelling) → examination under anaesthetic ± manipulation under anaesthetic reduction + post-op splinting (<2 weeks)
Septal haematoma → EUA and evacuation, packing and suturing

Question 4

What is a nasal septal haematoma

Answer 4

Development of a haematoma between the septal cartilage and the overlying perichondrium

Overlying perichondrium carries the vascular supply to the septum → disrupted by haematoma → septal cartilage loses vascular supply → ischaemic saddle nose deformity → septal necrosis → nasal collapse

Question 5

Symptoms and signs of a nasal septal haematoma

Answer 5

Precipitated by relatively minor trauma
Sensation of nasal obstruction
Pain and rhinorrhoea

Appearance of swelling in the nose
- Bilateral
- Boggy
this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm

Question 6

Management for nasal septal haematoma

Answer 6

Urgent referral to ENT
EUA and evacuation, packing, suturing
surgical drainage
IV antibiotics