Nasal Injury

Question 1

What are features of nasal fracture?

Answer 1

New nasal deformity

Associated facial swelling and black eyes

Question 2

What should you always look for in nasal trauma?

Answer 2

Septal haematoma: boggy swelling of septum causing near total nasal obstruction
Development of haematoma between the septal cartilage and the overlying perichondrium

Question 3

What are features of nasal septal haematoma? Management?

Answer 3

Precipitated by trauma
Sensation of nasal obstruction
Pain and rhinorrhoea
Bilateral, red swelling from nasal septum
Boggy not firm

Surgical drainage is required
IV abx

Question 4

What is management of nasal fracture?

Answer 4

Treat epistaxis
Advice on analgesia
Close skin injury
If MUA, can perform 10-14d after injury

Question 5

What is the risk of nasal risk haematoma?

Answer 5

Septal necrosis may develop within 3-4 days
Pressure related ischaemia of cartilage results in necrosis
May result in saddle nose deformity

Question 6

What causes CSF rhinorrhoea?

Answer 6

Ethmoid fractures disrupting dura and arachnoid can result in CSF leaks
IF not associated with trauma - tumour?

Question 7

How can you test for CSF in nasal discharge?

Answer 7

Tests +ve for glucose

Conatins B2 tau transferrin >0.5ml

Question 8

What is management of CSF rhinorrhoea?

Answer 8

Conservative management 7-10 days bedrestAvoid coughing, sneezing, nose-blowing
Surgery is often not required
Cover with abx and pneumococcal vaccine

Question 9

What is management for nasal foreign body?

Answer 9

Ask child to blow their nose
ask parent to do parental kiss - blowing into mouth whilst occluding other nostril
Refer to ENT

Question 10

What are causes of septal perforation?

Answer 10

Septal surgery
TRauma - nose picking, foreign body, lacerations septal haematoma
Inhalants - cousin abuse
Infection (TB, syphilis, HIV)

Irritate, white, crust, and bleed

Question 11

What is management of septal perforation?

Answer 11

Saline nasal irrigation, petroleum jelly to edge of perforation
Surgical closure via placement of septal prosthesis

Question 12

What is a septoplasty?

Answer 12

Correction of deviated nasal septum

Performed where there is nasal obstruction with no other identifiable cause and where conservative treatment has failed.

Question 13

What is a spetorhinoplasty?

Answer 13

Aims to straighten or refashion the shape of the nose for cosmesis and to help breathing by improving the airway

Question 14

What is post-op advice in septorhinopalsty?

Answer 14

Avoid blowing nose for 1 week

Saline nasal irritation with saline sniffs 4x a day for 2 weeks to prevent crusting

Question 15

What are complications of septorhinoplasty?

Answer 15

Bleeding 
CSF leakage
ALtered sensation of lips
Incise and drain septal haematoma if develops and give abx
Adhesions may require division

Question 16

What are sign/symptoms of nasopharyngeal cancer?

Answer 16

Neck lump (cervical lymphadenopathy)
Bleeding, obstruction, discharge nasal
Hearing loss - unilateral due to conductive deafness from Eustachian tube blockage
CN palsy

Question 17

What investigation and management of nasopharyngeal cancer?

Answer 17

Endoscopy and biopsy
MRI staging

Radiotherpay ± chemotherapy ± surgery

Question 18

What is nasal irrigation? How do you make the solution and use?

Answer 18

Patients sniff a saline solution into the nostril
Helps keep nose clea and removes debris
Prevents cyst from forming after surgery or epistaxis
Used in rhinitis clearing airway of irritants

1 flat teaspoon of salt and 1 of bicarbonate of soda into a bowl and add 1 pint of boiled boiled water

Squeeze solution up nostril 4 times each