Nasal Bone Fractures Epidemiology Adults -> 5% of all facial fractures Infants -> 16% of all facial fractures Causes Motor vehicle crashes and accidents Physical violence e.g. punches and elbowing. Sport related injuries Clinical features Epistaxis Swelling Ecchymosis Tenderness of nasal bridge Crepitus upon palpation Cracking sound on palpation Indicates a fracture but rarely present Possible inability to breath through one or both nasal airway obstruction. Diagnostics Physical examination External examination: Epistaxis CSF rhinorrhoea Airway obstruction Septal hematoma Septal deviation Internal examination Do this after the swelling has resolved. CT head or high-resolution CT of the face: Not indicated or isolated uncomplicated nasal fracture Indicated if other facial fracture and/or skull fractures are suspected and prior to the surgical reduction. Treatment and Management Initial management: Head elevation Pain management Ice packs Epistaxis control with compression or if necessary anterior packing. Definitive treatment: Conservative management: For uncomplicated nasal fractures. Displaced nasal fractures -> no further treatment Operative management: For complicated nasal fractures Complications Nasal septal hematoma Collection of blood around the nasal septal bone or cartilage with intact nasal mucosa Caused by nasal or fascial trauma . Diagnostics: Rhinoscopy showing unilateral or bilateral balloon like bloody protrusion. Treatment and management: immediate surgical drainage Complications: Infection Septal perforation Nasal deformities Nasal sepal perforation secondary to nasal hematomas Saddle nose deformity Deviated nasal septum Nasal ventilation problems or snoring