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Nasal fracture (Clinical
presentation (Pain, Nasal deformity, Epistaxis
…
Nasal fracture
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Diagnosis
(clinical)
Examination
ENT exam
External nose: look from above and behind -
swollen, tender, deformity/deviation, rhinorrhoea, haemorrhage
Internal nose: can patient breathe through both nostrils?
any obvious septal deviation or haematoma
Facial/C-spine exam
Facial/head: check for associated injuries
(crepitus, swelling, lacerations, ecchymoses)
C-spine: check for associated injury
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Investigations
Bloods
Crossmatch, G&S, FBC, U+E
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History
DH:
Meds (intranasal steroids/decongestants),
allergies
SH
Living arrnagements, occupation,
alcohol, smoking, drugs
PMH
Previous facial/nasal trauma,
ENT problems, coagulopathy
HPC: mechanism of injury, time since injury,
associated injuries and symptoms
Management
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Definitive
Medical
Analgesia
Indication: pain, swelling
e.g. NSAID PO
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Conservative
Refer to ENT and maxfax (severe deviation, severe epistaxis, septal haematoma, CSF rhinorrhoea, other fractures, CN lesions_
Treat associated epistaxis
Clean and close overlying wounds
Ice pack (reduce sweling)
Surgical
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MUA
Indication: nasal deviation/deformity
MOA: MUA (GA/local) at 5-7d (reduced swelling);
before 14d (otherwise bones have fused)
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