A careful history can usually ascertain the severity of trauma incurred. In cases where the forces involved are severe, the physician must be suspicious of cervical spine injury or closed-head injury. These injuries take precedence over any concurrent nasal fracture. Epistaxis may be frequently associated with nasal trauma.
Findings suggestive of a nasal fracture include swelling, tenderness, crepitance, ecchymosis, or nasal deformity. Indirect evidence of nasal fracture include periorbital ecchymosis, epistaxis, and rhinorrhea. A general physical exam, specifically focused on the head, neck, and neurologic system, is necessary to exclude associated injury.
After spraying the nasal mucosa with a vasoconstricting agent, search for defects in the mucosa, septal hematoma, and bony displacement. Finally, palpate the injured nose checking for crepitance, stepoffs, and instability. Severe edema often precludes immediate detection of nasal fractures.
The diagnosis of nasal fracture is predominately based upon historical and physical exam findings. Nasal radiographic studies are usually not required for diagnosis or management. Radiographic imaging selection depends upon suspicion of other associated facial fractures.
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