Nasal fractures
Nasal fractures are common after blunt facial trauma. Although most are isolated and benign, they can indicate more serious facial or cranial injury.
Emergency assessment therefore prioritises life‑threatening problems and identification of complications that need urgent specialist input, notably septal haematoma and cerebrospinal fluid (CSF) leak. Follow local ENT and major haemorrhage pathways where relevant (NICE ENT topic; RCEM; NICE NG24).
Overview and priorities
- Perform a primary survey first (airway, breathing, circulation, disability, exposure/evaluation). Manage airway, breathing and circulation problems before addressing the nose.
- Identify red flags: reduced conscious level, focal neurology, visual disturbance, gross mid‑face instability, profuse or uncontrolled bleeding, and signs of skull‑base fracture.
- Control bleeding, provide analgesia and cold packs, inspect for open wounds and consider tetanus status.
- Recognise septal haematoma and suspected CSF rhinorrhoea; both require urgent specialist review.
History and focused assessment
- Mechanism and timing of injury.
- Anticoagulant or antiplatelet use and any reversal or monitoring history.
- Prior nasal or facial surgery.
- Symptoms: epistaxis, nasal obstruction, rhinorrhoea (character and laterality), anosmia, diplopia or visual change, and facial numbness.
- Examine for associated injuries, including orbital, dental and Le Fort pattern fractures.