Disease Information for Fracture, nasal bone

Nasal bone fracture: minor nasal trauma history; Epistaxis; observe for associated injuries with Cervical Spine Injury; Mandibular fracture; Facial fracture; Zygomatic arch fracture; Maxillary sinus fracture; Orbital fracture; External exam: Clinical diagnosis (not radiographic); Localized Edema and Ecchymosis of nose; Nasal deformity: Birds Eye View;Palpate nose for crepitation or step-offs; Compare to photo before injury (best available); Use driver"s license if others not available; Internal exam; Apply anesthesia and vasconstrictor to mucosa and nasal speculum exam Assess Nasal Airway patency; Assess for continuing Epistaxis ; Assess turbinates: Septal Hematoma ; clear Rhinorrhea (possible CSF) Complications: Evaluate for in all cases; Septal Hematoma: Observe for white or purple swelling on septum; Depress septal mucosa to check for fluctuant area; Failed diagnosis may result in saddle deformity; CSF Rhinorrhea: Presents as clear Rhinorrhea; Double Ring Sign (variable efficacy); Place bloody Nasal discharge on filter paper May form double ring on paper if CSF present; Immediate consultation indications: Cerebrospinal fluid leak suspected; Limited extraocular movement (orbital fracture); New malocclusion of teeth (jaw joint or mandibular fracture); Altered mental status (closed head trauma/concussion); Radiology: Nasal X-Ray is not recommended; Low Test Sensitivity and Test Specificity instead Coronal CT of facial bones Indications Suspected facial fracture or Clear Rhinorrhea with CSF leak suspect; Closed Reduction Administer Conscious Sedation and analgesia; (Versed and Morphine IV Titrate to adequate effect) ; Instruments used Asch forceps and Walsham forceps or Boies elevator (preferred)---------[adapted Family Practice Notebook 2004]-----------

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