Nasal fractures are among the most common facial injuries, often caused by blunt trauma from accidents, sports, or physical altercations. Once a nasal fracture is suspected, it is essential to consult an ENT specialist for proper assessment and treatment. These medical professionals specialise in diseases affecting the ear, nose, and throat and are trained to treat both functional and structural nasal injuries.
Initial Assessment and Diagnosis
Once a patient presents with a suspected nasal fracture, an ENT specialist begins with a detailed medical history and a physical examination. This step typically involves checking for external deformity, swelling, bruising around the eyes, nasal bleeding, and tenderness over the nasal bridge. The patient may also report symptoms such as difficulty breathing through the nose, a deviated nasal shape, or crepitus, which refers to a crackling sound or sensation caused by fractured bone fragments rubbing together.
Due to the swelling that usually develops within hours of injury, immediate physical inspection may not provide a complete view. In some cases, the specialist may advise waiting 3–5 days for the swelling to subside before conducting a follow-up examination. This delay allows for better visualisation of the nasal structure and helps in planning any necessary intervention.
Although nasal fractures can often be diagnosed clinically, imaging may be required in certain situations. A plain X-ray has limited value for nasal fractures. However, a CT scan is considered more objective, especially when there is suspicion of complex facial fractures or involvement of adjacent structures, including the eye socket or sinus cavities.
Classification of Nasal Fractures
ENT specialists classify nasal fractures based on their complexity and displacement. A simple, non-displaced fracture may not alter the shape of the nose and might heal without surgical intervention. In contrast, a displaced fracture may cause visible deformity and nasal obstruction, necessitating manual realignment or surgical correction. Comminuted fractures, where the bone is broken into several pieces, typically require more extensive treatment and sometimes concurrent management of cartilage damage.
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Treatment Options
The treatment approach for a nasal fracture depends on the severity of the injury, the timing of the presentation, and the patient’s symptoms. For minor, non-displaced fractures, conservative management with analgesia, ice application, and rest is usually sufficient. The specialist may also advise avoiding contact sports or strenuous activities for several weeks to prevent further injury.
Once the nasal bones are displaced, closed reduction is often performed. This approach is a manual procedure where the bones are realigned under local or general anaesthesia. ENT specialists typically carry this out within 7–10 days of the injury, before the bones begin to heal in a misaligned position. If the fracture is detected after this window, the bones may have started to fuse, making surgical correction more complex.
An open reduction surgery may be required in cases where closed reduction is not possible or unsuccessful. This surgery involves making an incision to access and reposition the bones. Reconstruction may also be necessary if there is significant damage to the nasal septum or cartilage. Functional concerns such as nasal obstruction are also addressed during surgical correction, often in combination with septoplasty procedures.
Post-Treatment Care and Monitoring
Following any intervention, patients are advised to avoid pressure on the nose, refrain from wearing glasses that rest on the nasal bridge, and attend follow-up appointments to monitor recovery. Splints or nasal packing may be used temporarily to support the nasal structure and minimise swelling. ENT specialists also assess for late complications such as persistent nasal blockage, septal deviation, or cosmetic asymmetry, which may require further treatment.
Injury to the nasal septum can result in the formation of a septal haematoma, which must be drained promptly to prevent cartilage damage. Chronic issues following nasal fractures, such as breathing difficulty or aesthetic deformities, may necessitate corrective rhinoplasty at a later stage.
Conclusion
ENT specialists are integral in diagnosing and treating nasal fractures. Their approach combines clinical examination, imaging when necessary, and intervention tailored to the extent of the injury. Prompt care is critical for restoring nasal function and avoiding long-term problems. Patients experiencing trauma to the nose with signs of fracture should seek early evaluation from a qualified ENT specialist to ensure proper care.
Contact Dr Dennis Chua for an evaluation and treatment plan tailored to your ENT condition.
