Nasal Trauma Flashcards
Which important finding must be checked for following nasal trauma?
Septal haematoma
What are the features of a septal haematoma?
On anterior rhinoscopy
- -> boggy, red/purple swelling from nasal septum
- fluctuant (differentiate from deviated septum)
How is a septal haematoma managed?
Incision + drainage under GA
What are the complications of an untreated septal haematoma?
AVN of septal cartilage
–> susceptible to infection + abscess formation
Over a long period can result in septal perforation or ‘saddle nose’ deformity
What is the initial management of a nasal fracture?
Check for septal haematoma –> needs urgent management
Usually too swollen to be examined for fracture
No role for xray in isolated nasal fracture
–> seen in ENT clinic 5-10 days post injury
How is a suspected nasal fracture assessed in the ENT clinic?
Nasal deformity:
- inspect for bony or septal deviation
- patient’s opinion on appearance of nose
Nasal obstruction:
- ask about symptoms
- assess air flow by holding metal item under nose and look for mist
How is a nasal fracture managed?
Manipulation under anaesthetic
- either local anaesthetic in clinic or under GA
- within 14-21 days of injury
What can be done for a nasal fracture is the result of manipulation under anaesthetic is aesthetically unsatisfactory?
Definitive surgery:
- rhinoplasty changes shape of nasal bones
- septoplasty alters nasal septum
Which artery is the bleeding usually coming from in a traumatic epistaxis?
Anterior ethmoidal
–> therefore often more likely to require surgical intervention
How does CSF leak occur following nasal trauma and how does it present?
Fracture of cribriform plate –> CSK leak out of nose
Presents as persistent clear rhinorrhoea
How can you confirm a CSF leak from the nose?
Test fluid for high levels of beta-2 transferrin
