Clinical features

These will depend upon the severity of the fracture but may include:

• nasal deformity
• nasal obstruction
• epistaxis
  • in some nasal fractures, epistaxis without obvious nasal deformity may be the only clinical finding.(1)
• oedema and ecchymosis of the nose and periorbital structures
  • this may be seen if examination is performed more than several hours after the injury.
• palpation of the nasal structures may elicit any crepitus, indentation, or irregularity of the nasal bone.
• soft tissue injury - swelling and discolouration about the nasal bones and the vicinity
• nasal injury may be associated with other head and neck trauma (1)
  • the possibility of an associated facial or mandibular fracture must be considered
    • this requires computed tomography (CT)
  • all bony structures of the face( malar eminences, orbital rims, zygomatic arches, mandible, and teeth) should be carefully examined
  • eyes - symmetry and mobility of gaze should be looked for(1)
• a thorough internal examination requires the folowing:
  • good lighting
  • suction
  • anesthesia
  • vasoconstrictive nasal sprays.
  • a nasal speculum
  • a headlamp

References:

• (1) Corry J. Kucik, et al. Management of acute nasal fractures. Am Fam Physician 2004;70:1315-20