Nasal Trauma

 

This guideline applies to adults aged 16 years and over.

 

Introduction

Nasal injuries can result in damage to skin, bone, cartilage or any combination. If the skin is cut it will require cleaning and closing, with consideration of a tetanus vaccination if not up to date. Nasal fractures can cause significant swelling, which usually takes about 5-7 days after the injury to subside. It is difficult to examine the nasal bones until the swelling has gone down.

 

 

Red Flag Features

• Septal haematoma
   
• Significant head injury
   
• Other facial fractures, suggested by:
  • Palpable step in orbital rim
  • Orbital swelling or haematoma
  • Infraorbital paraesthesia
  • Dental malalignment
  • Surgical emphysema in soft tissues of face
• Significant facial laceration

 

 

Key Features of Assessment

• Mechanism of injury
   
• When the injury occurred
   
• Whether there is:
  • deformity of the nose
  • new nasal obstruction
• Exclude red flags
   
• Associated facial injuries, including skin lacerations
   
• Patient and/or practitioner concerns

 

 

Investigations

Facial x-rays are not required or recommended prior to referral, unless other facial fractures are suspected, in which case the patient will probably be attending the Emergency Department for assessment.

 

 

Management and Referral

Septal haematoma

Arrange admission via discussion with ENT first on-call.

 

Significant head injury

Head injury meeting NICE [NG232] criteria 1.2.4– arrange admission to the Emergency Department.

 

Other facial fractures

Arrange admission to the Emergency Department if clinical concern of:

• Palpable step in orbital rim
   
• Orbital swelling or haematoma
   
• Infraorbital paraesthesia
   
• Dental malalignment
   
• Surgical emphysema in soft tissues of face

 

Significant facial laceration

Arrange admission via discussion with MaxFax on-call if lac requires wound closure beyond general practice expertise.

 

Skin lac

Small wounds can be closed in general practice if expertise and equipment are available. Consider tetanus vaccination if not up-to-date.

 

Epistaxis

If associated nosebleed, follow the Acute Epistaxis guideline.

 

 

Nasal trauma

See links to:

• Patient information on Nasal Trauma
• Nasal Steroids

 

Advice and Guidance

Contact ENT first on-call if immediate advice is required regarding reduction of nasal fracture sustained within 14 days.

If diagnostic uncertainty, in patient presenting more than 14 days since injury, consider seeking ENT Advice & Guidance.

 

Supporting Information and References

For professionals:

ENT UK – Nasal Trauma guidelines

 

For patients:

ENT UK – Nasal Injuries

NHS – Broken Nose

 

 

Page Review Information

 

Review date	15/03/2024
Next review date	15/03/2026
Specialty Lead GP	Dr Laura Vines
Contributors	Ms Aileen Lambert, ENT Consultant Surgeon Mr Neil Tan, ENT Consultant Surgeon