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Background
Traumatic nasal injuries are common in all age groups of the community. Significant nasal trauma can cause nasal fractures and a range of complicating injuries.
Objectives
This article provides general practitioners (GPs) with a succinct overview of pathology arising from nasal trauma, and a framework on the assessment and management of common nasal injuries.
Discussion
During assessment of traumatic nasal injuries, it is essential to exclude a septal haematoma, which requires urgent drainage. Undisplaced nasal fractures without functional symptoms can be managed conservatively. Displaced fractures should be referred for reduction. There is a window of two weeks before the displaced nasal bones start uniting. Investigations are rarely indicated for traumatic nasal injuries. Blood tests, including full blood count and coagulation screening, may be indicated in severe epistaxis. X-rays are not helpful for the assessment of traumatic nasal injuries. Computed tomography (CT) scans are only indicated if there is a suspected orbital, maxillary, frontal or zygomatic fractures.
The nose is the most prominent feature projecting from the face and is prone to injury arising from facial trauma. Injury can occur in all age groups and from a variety of causes, which may be either blunt or penetrating. The majority of injuries result in either bruising alone or a simple nasal fracture. Nasal fractures should be referred to ear, nose and throat (ENT) or maxillofacial services for prompt reduction (ideally one to two weeks from injury).
Complicated injuries include suspected facial fractures, full thickness lacerations, septal haematoma, septal abscess and cerebrospinal fluid (CSF) leak. It is critical that these are recognised early and managed appropriately in primary care.
Anatomy
The nose can be subdivided into thirds. The upper third is made up of the paired nasal bones, which are attached to the frontal bones superiorly, forming a pyramid-shaped bony vault. The perpendicular plate of the ethmoid fuses with the nasal bones on the inner aspect, providing additional support. The middle third is composed of the quadrilateral cartilage of the septum in the midline and the upper lateral cartilages laterally. The lower third contains fibrofatty soft tissues of the nasal tip, supported by the lower lateral (alar) cartilages (Figure 1).
The nerve supply is from the ophthalmic and maxillary divisions of the trigeminal nerve. Blood supply...