injuries poisoning
Fractures of the Nose
Treatment of Nasal Fractures
Symptomatic care For septal hematomas, immediate drainage For deformities, delayed reduction Immediate treatmentincludes symptomatic control with ice and analgesics. Septal hematomas must be immediately incised and drained to prevent infection and cartilage necrosis. Reductionis needed only for fractures causing clinically visible deformity or nasal airway obstruction. The end-point of reduction is determined by clinical appearance or improved airway. Reduction is usually deferred for 3 to 5 days after injury to allow swelling to subside but should take place within 2 weeks of the injury, before bony callus formation. Nasal fractures in adults may be reduced after a local anesthetic is given; children require general anesthesia. A blunt elevator is passed through the nares and placed under the depressed nasal bone, which is lifted anteriorly and laterally while pressure is applied to the other side of the nose to bring the nasal dorsum to the midline. The nose may be stabilized with internal packing (consisting of antibiotic-impregnated strip gauze, silicone elastomer sponges, or similar products) placed high within the nasal vestibule, as well as with external splinting. Internal packing is left in place for 4 to 7 days; external splinting is left for 7 to 14 days. Antibiotic prophylaxis effective against staphylococci is required for the duration of nasal packing to decrease the risk of Toxic Shock Syndrome (TSS) . Cartilaginous injuries often do not require reduction. In the rare circumstance that a deformity persists after swelling subsides, a reduction and splinting after a local anesthetic is given are usually sufficient. Septal fracturesare difficult to hold in position and often require septal surgery later. Cribriform plate fractures with cerebrospinal fluid (CSF) leakrequire hospital admission with bed rest, head elevation, and placement of a lumbar drain. Drain management and need for antibiotics vary by institution. If the CSF leak does not resolve, surgical repair of the skull base may be required. 