Nasal Fractures

Assess for septal haematoma, fluctuant swelling on nasal septum, normally bilateral. If present needs same day drainage.

If the nose is a different shape from before and the patient would want a manipulation for cosmetic reasons then arrange for follow up in 5-7 days in ENT clinic (Thursday morning in ED if available otherwise email ENT@borders.scot.nhs.uk) or Emergency Department practitioner who is happy to manipulate noses.

Manipulation of Nasal Fracture Under Local Anaesthetic

Assessment

Assess deviation of nasal bones by assessing alignment of upper third of nose with middle of chin from in front of the patient and then standing behind patient looking down with patients head tilted back so that you can see the nasal bones and the chin.

Anaesthetic

Option 1

5-10mils of 2% Lidocaine injected over nasal bones bilaterally going down to bone then leave 10 minutes. Warn patient that this will cause significant short term (<1 hour) swelling over nose.

Option 2

3 sprays Lidocaine 5% with Phenylephrine Hydrochloride 0.5% (comes in blue plastic container) each nostril. Then top bottle up with 10% Lignocaine spray. Insert a 5cm roll of cotton wool soaked in this solution into each nasal cavity with Tilley dressing forceps. The cotton wool should be inserted along the length of the nasal cavity and then be pushed superiorly towards the nasal bones. Then leave 10 minutes. Remove cotton wool at end of manipulation.

Manipulation

Manipulate nose, with patient lying on bed, standing at the head end of the bed. With your open hand on each side of the head manipulate the nose with your thumbs.

No dressings or follow up are required.