NASAL TRAUMA

Question 1

DDx

Answer 1

Intracranial Injury
Frontal Bone Fracture
Orbital Fracture
Globe Injury
Midfacial Fracture: LaFort I-III
Mandibular Fracture
Dental Injury
C-Spine injury

Question 2

KEY CONCEPTS

Answer 2

HISTORY AND PHYSICAL
focus on assessing for concomitant head, cervical spine, midface, or globe injuries.

RULE OUT:
Nasal Septal hematoma

Question 3

MANAGEMENT

Answer 3

HEMOSTASIS

Nasal Packing if NO significant concern for skull base fracture

TXA 500 mg soaked in gauze or cotton inserted into the bleeding nare for 10-30 min

ANALGESIA

Topical lidocaine

ANTIBIOTICS

Open fractures / fractures that communicate with sinuses

Clavulin 875 mg PO bid 3 to 5 days

IMAGING

Diagnosis based on history and physical
CT facial bone only indicated if concern for any other fracture

REDUCTION

ED reduction not required, MAY BE ATTEMPTED if significant lateral deviation

Closed reduction with ENT within 1-2 weeks for adults and 7-10 days for pediatrics

DISPOSITION

Admission:

Patients with airway compromise or life-threatening/uncontrolled bleeding

Patients with associated life-threatening injuries

Patients with intractable pain or inability to tolerate oral medication

Discharge:

Majority of patients

Absence of septal hematoma

Question 4

DOCUMENTATION

Answer 4

HISTORY

Ask about:

Mechanism of injury
Timing of injury (of any laceration)
Use of protective gear

Visual change
Facial Numbness
Changes in dental occlusion

LOC
Headache
Nausea / Vomiting
Neck pain

PHYSICAL EXAM

Document:

Swelling, erythema, bruising, deformity

Nasal mucosa

SEPTAL HEMATOMA

Rhinorrhea or Otorrhea

Naris patency

Telecanthus

Epiphora (overflow of tears onto the face).