Case 1 Nasal Fractures
Obvious nasal deformity with deviation of the nasal dorsum to the left
Overlying soft tissue injury and swelling
Periorbital ecchymoses, primarily on the right side
Presumed nasal airway obstruction, particularly on the right side
Mechanism of injury: Helpful in determining angle and magnitude of force
Previous fractures or injuries to the nose
History of facial surgery, particularly nasal or septal surgery. Septoplasty, in particular, would raise concerns about adequate septal support. This may also eliminate the possibility of cartilage graft harvest from the nose, if necessary
Premorbid nasal airway patency
Medications, particularly anti-platelets or blood thinners
1.2.2 Physical Examination
Advanced Trauma Life Support (ATLS) protocol: Identify any potentially life-threatening conditions.
Detailed examination of the face, including evaluation for sensory and motor changes, and eye, midface, and intraoral injury.
Nasal examination: Evaluate for tenderness, crepitus, or step-off. Assessment of nasal dorsum for straightness, position to midline, and lateral profile. Speculum examination to assess septum for deviation and septal hematoma.