- History of recent trauma to midface; should assess mechanism of injury, presence of epistaxis or rhinorrhea, history of previous injury, and new onset of nasal airway obstruction or deformity.
- On examination, note any mucosal laceration, septal disruption, or septal hematoma.
- Depending on severity of insult, must rule out concurrent injury to eyes, lacrimal system, paranasal sinuses, teeth, and oral cavity.
Nasal fracture as a result of trauma to the midface is considered the most common of head and neck fractures. Frequently the result of physical altercation, nasal trauma is most often not life-threatening; however, significant functional and aesthetic impairment may result if these injuries are not accurately diagnosed and addressed in a timely fashion.
The incidence of nasal fracture is high in both adults and children. Of maxillofacial injuries, fractures of the nasal bones account for up to 39–45% of cases reported in adults, and up to 45% of injuries in children. In adults, the highest rates of incidence are found among men, with a 2:1 predominance over cases reported in women. In men, nasal fracture is most often associated with intentional trauma and is clearly more common in the 15- to 25-year age group. In women, nasal trauma is usually the result of personal accidental injury; most commonly the result of falls and is often seen in patients over the age of 60.
In children, a clear gender predilection for injury is less likely, although cases are more often reported in boys. Also, more cases of nasal trauma in children are the result of accidental injury related to sports and play rather than physical confrontation. It is important to note, however, that anywhere from 30% to 50% of all pediatric victims of abuse present with maxillofacial injury, a concern not to be overlooked, particularly when evaluating the possibility of fracture concealed by the presence of facial edema.
Given the central and prominent position of the nasal bones and the significant lack of skeletal support for their position, the nose is particularly vulnerable to fracture as a result of maxillofacial injury. Reports indicate that the amount of force required to create a fracture of the nasal structure is small, possibly as little as 25 pounds of pressure. Superiorly, the structure of the nasal bones thickens with support from the underlying nasal spine of the frontal bone, an area more resistant to injury than the distal, thinning segment of the nose, which is unsupported and much more often the location of a fracture.
Trauma to the nasal cartilage, either from a directed frontal or inferior assault or from an indirect lateral injury, often results in displacement, dislocation, or avulsion rather than true fracture. The physical elasticity and flexible attachments of the nasal cartilage allow for the significant absorption and dissipation of energy, thus preventing considerable injury from a greater amount of force than the bony structure would tolerate. The nasal septum, however, is ...