Nasal Injury and Foreign Body

Question 1

What is this a presentation of?

Direct trauma from punch or fall, nasal deformity, septal haematoma (usually bilateral), near total nasal obstruction.

Answer 1

Nasal fracture

Question 2

What must you exclude in a suspected nasal fracture?

Answer 2

Significant head or c-spine injury

Question 3

What is the management for a nasal fracture?

Answer 3

1. Urgent incision and drainage under GA of septal haematoma

2. Reassess 1 week post-injury, can manipulate under anaesthetic (2 weeks after injury)

Question 4

What causes CSF rhinorrhoea?

Answer 4

Ethmoid fracture disrupting dura and arachnoid can result in CSF leaks.

Question 5

How is CSF rhinorrhoea diagnosed?

Answer 5

Test for B2 (Tau) transferrin as gold standard

Question 6

How is a foreign body in the nose managed?

Answer 6

1. Ask child to blow their nose
2. Parent can try blowing into child’s mouth while occluding other nostril.
3. Refer to ENT if this fails - batteries need urgent removal