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
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Septal haematoma
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Significant head injury
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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
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Mechanism of injury
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When the injury occurred
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Whether there is:
- deformity of the nose
- new nasal obstruction
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Exclude red flags
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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.
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:
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:
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 |