Case 1 Nasal Fractures

Charles C. Jehle and Albert S. Woo

Case 1 Nasal Fractures

Case 1 (a, b) A 63-year-old man presents to the emergency department complaining of nasal pain after falling on his face.

1.1 Description

  • 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

1.2 Work-Up

1.2.1 History

  • 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.

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 1 Nasal Fractures

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