Section 8

A 32-year-old gentleman was punched in the face one week ago.


Describe the deformity

Clinical photograph of nasal bone fracture, bones to the right?

What early treatment option would you offer and why is the timing important?

  • Manipulation under anaesthetic
  • This needs to be performed within 3 weeks, prior to the bones healing, preventing movement.

Describe three potential complications associated with injury.

  • Septal haematoma
  • CSF leak
  • Nasal obstruction

Describe three potential complications associated with injury.

  • Septal haematoma
  • CSF leak
  • Nasal obstruction

Supporting Information

Nasal trauma- Assault, RTA, Sport, Falls. 

  • Management – dealing with epistaxis, haematoma, check trigeminal sensation, ocular movements, and ABCDE etc. 
  • Simple fractures see in the clinic 5-7 days later (oedema can settle). May need a splint. 
  • MUA (with digital pressure or Walsham’s forceps) within 2 weeks.
  • Septorhinoplasty may be necessary. Before doing surgery for children- wait until late teenage years so bone structure has fully developed. 

Fracture nasal bones may have complications:

  • Septal haematoma- cherry red swelling in mucoperichondrium. Bilateral needs I+D. 
  • Watery rhinorrhoea may be CSF leak- cover with abx, may need surgical closure with temporalis fascia.
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