Nasal Trauma

If the skin is cut it requires cleaning and closing using either sutures or self-adhesive strips. An injection to prevent tetanus is advisable if your vaccination is not up to date (every 10 years) and you may require antibiotics.

The nasal bones are the most commonly broken bones of the face as they have an exposed, prominent position and little structural support. X-rays have little value in confirming or ruling out this condition due to the difficult imaging of these bones (plain films miss approximately 50% of fractures).
Therefore, the management of nasal injuries is guided only by the clinical findings. If any X-rays are deemed necessary, it is only for suspected involvement of other important facial structures such as eye (orbits), cheekbones and jawbones.

The signs and symptoms of nasal fracture include:

• obvious deformity or deviation of the nose
• instability and crepitus (clicking)
• obstructed nasal passages (blocked nose).

If the nose is bruised and a fracture is suspected, the emergency department clinician will refer you to be seen by the Ear, Nose and Throat (ENT) team usually within two weeks of the injury.

This time frame is to allow the swelling of the nose to settle so that an adequate assessment can be undertaken. It may be that the shape of your nose will revert to its usual form once the swelling subsides.

In the mean time, you may take regular pain relief medication (for example paracetamol or/and ibuprofen) and place ice packs on your nose to help with the swelling.

When you are seen in the ENT department, your nose will be assessed for suitability of manipulation of the nose bones under an anaesthetic. This must take place within three weeks of your nose injury.

• Nosebleeds (epistaxis) – these are common and usually settle on their own with simple first aid by gently pinching the lower half of the nose for 15 minutes. Nasal packing or cautery are rarely needed and reserved for nosebleeds that do not stop of their own accord.
  
• Septal hematoma – blood (haematoma) can collect under the lining of the central partition (septum) of the nose causing a purple swelling inside the nose. If this occurs it will give you a blocked nose and pain and will need treating by draining the blood away as soon as possible. If left untreated, the nose can become infected and result in a permanent deformity (saddle nose). Your emergency department clinician will check for this before you are sent home.
  
• Septal deviation – the midline partition of your nose (septum) can be bent to either side after a nose injury.
  This may give you symptoms of a blocked nose. The ENT team will check for this when they see you and advise if any medication or surgery is recommended. Surgery (septoplasty) is usually performed several months after nasal trauma as the septal swelling and bruising needs to have completely settled.
  
• Facial bone fractures – severe trauma to the face can cause fractures of other bones. This may result in changes to vour vision, bruises around your eyes, clear fluid dripping from your nose or ears and reduced sensation to parts of your face. You may need to be referred to the relevant specialities if such injuries are suspected. Your emergency department clinician will check for this before you are sent home.
  
• Anosmia (loss of sense of smell) – the smell organ in the roof of the nose can also be damaged. This may or may not return. You can speak to your doctor or ENT surgeon about this if your sense of smell has been affected and you would like further information.

To find out how to give us feedback on your visit or healthcare experience, please visit www.esneft.nhs.uk and search for ‘PALS’ or ‘Your views matter’, or speak to a member of staff on the ward or department you are in.