The most important assessment of nasal lacerations is to determine their depth and the involvement of the deeper tissue layers. Exposed cartilage or penetration through all tissue layers increases the risk of infection. When there is septal trauma, the presence of a hematoma underneath the cartilage and its protective mucoperichondrial layer may eventually lead to permanent thickening of the septum, causing partial airway obstruction of the nasal passage. Alternatively, the pressure exerted by a large, untreated septal hematoma may cause necrosis and subsequent erosion of the septum, enabling communication between the nasal passageways. Besides the annoyance to the patient, it may lead to a cosmetic saddle-nose deformity. If the mechanism of injury included a blunt force delivered to the nose, the presence of cerebrospinal fluid rhinorrhea should be sought to diagnose a possible injury to the cribriform plate.
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