Nasal Injury and FBs

Question 1

Nasal Injury Epidemiology

Answer 1

• Nasal fracture more common in men 15-30 years old

- Most common facial traumas

Question 2

Nasal Injury Assessment

Answer 2

• Search for other facial injuries to exclude significant head injury
• MOI
• Timing, after 4 hours swelling may obscure diagnosis
• Start examination distally and move proximally, examine intransally
• In rinorrhea, epistaxis implies fracture, test any clear fluid for CSF
• Test facial sensation
• Diagnosis usually clinical

Question 3

Nasal Injury Refer to ENT If

Answer 3

• Marked deviation
• Persistent epistaxis
• Septal haematoma
• CSF rinorrhoea
• Widened intercanthal distance
• Facial anaesthesia, facial or mandibular fracture and ophthalmoplegia required urgent referral to maxfax

Question 4

Nasal Injury Management

Answer 4

• Discharge and review in 5 days if no significant swelling or deformity
• Refer to ENT if nasal deviation
• Fracture reduction under local anaesthetic
• Antibiotics if lacerated

Question 5

Nasal Foreign Body

Answer 5

• Beads, buttons, sweet, nuts
• May present late with discharge
• Refer if prolonged discharge, posterior FB, agitated patient or if uncertain
• Topical anaesthetic and vasoconstrictor
• Blow positive pressure
• Use device to hold object
• Can sometimes use strong suction
• Pass narrow balloon catheter
• Examine ears and sinuses as AOM or sinusitis are commonly seen
• Refer to ENT if unsuccessful after two attempts