Nasal trauma Flashcards
What is shown?
Nasoseptal haematoma
What is the management of nasoseptal haematoma?
Always refer to ENT - risk of avascular necrosis
Drain within hours
Send swabs/aspirate for MCS
Pack nose after draining
What is the main complication of nasoseptal haematoma?
Avascular necrosis of the septum
What is shown?
Nasal speculum aka Thudicum
What is shown?
Foreign object in nose
How do nasal foreign objects present?
- Usually children - may be witnessed
- Unilateral, foul-smelling nasal discharge
What are the red flags for nasal foreign objects?
Object is a battery, magnet or has been inhaled
What is the management of nasal foreign bodies?
- Collateral hx
- Examination with thudicum
- Mother’s kiss - one nostril is occluded and mum blows into the mouth of the child in an attempt to dislodge the object
- Removal under direct vision
- Removal under GA
In facial trauma, what questions should be asked in the history?
Can you breathe through both sides of your nose?
Are you having any trouble speaking ?
Do you have double vision or trouble with your vision?
In your hearing normal?
Have you had previous facial injuries or surgery including procedures to correct vision?
What are the clinical features of nasal fracture?
- deformity
- obstruction
- epistaxis
- oedema and ecchymosis of the nose and periorbital structures
- palpation of nasal structures may ellicit crepitus, indentation or irregularity
- soft tissue injury
- other head and neck trauma - ?CT needed
When would you refer a nasal fracture immediately to the hospital?
Septal haematoma - swelling of septum on looking up the nose with a thudicum - if untreated leads to necrosis of cartilage, collapse of the bridge and saddle nose
Other facial or skull fracture e.g.
- diplopia, limited extraocular movement
- numbness of cheek
- malocclusion of teeth
- trismus (spasm of V)
- CSF rhinorrhoea
- anosmia
- subcutaneous emphysema
- mental status changes
What are the complications of nasal fracture?
- Septal haematoma
- Epistaxis
- Nasal deformity
What is the management of nasal fractures?
- A to E assessment
- Control epistaxis, inspect for nasal haematoma, clean and suture lacerations
Later:
- Reduction - consider correction if there is deformity present and patient is concerned about it.
NB: correction may be futile if the patient habitually breaks their nose e.g. boxer or footballer.
Describe how nasal reduction is done.
Timing:
* Immediately - before swelling
* After 7-10days - once swelling has settled but nose can still be manipulated
* Late - if too late for reduction then septorhinoplasty will be required
Analgesia: local or general anaesthetic
Technique:
- Closed reduction - limmited to mild unilateral fractures, can be done in primary care
- Open reduction - operating theatre
Usually audible click is heard when pressure is applied, depressed bones may need elevation with forceps and a nose which is unstable after reduction shoudl be splinted with plaster of Paris.
