A 30-year-old male presented with swelling and bruising of the nose after trauma. Examination revealed a depressed and deviated nasal bone with septum deviation, consistent with a nasal fracture. Nasal fractures are generally classified as depressed or angulated, depending on the direction of force. Common clinical signs include swelling, bleeding, bruising, deformity, and nasal obstruction. Diagnosis is made through physical exam and x-rays. Treatment involves closed reduction using manipulation and tools to set displaced bones, or open reduction surgery if closed fails or for abnormal healing.

1. Trauma of nose
Muneeb Ali Tasleem
Muhammad Zulqernain

2. Case presentation:
 A 30 year old male patient presented in
emergency department with swelling of
nose and periorbital ecchymosis. The nose
was bleeding profusely and was tender to
touch. On examination the nasal bone was
depressed and septum was deviated to one
side.

4. Anatomy of nose

6. Types of nasal fractures
Depressed fracture:
Due to frontal blow
Open book fracture of nasal bones
Septum is collapsed(splayed out)
Flattening and widening of dorsum

7. Angulated fracture:
Due to lateral blow
Unilateral fracture/fracture of nasal
bone and septum
Deviation of nasal bridge

9. Clinical features:
 Swelling of nose
 epistaxis
 Periorbital ecchymosis
 Tenderness
 Nasal bone deformities
 Crepitus and mobility of fracture fragments
 Nasal obstructions
 Septal hematoma
 lacerations

10. Diagnosis
Physical examination( gold standard)
X rays(water’s view, right and left
lateral view and occlusal view)

11. Treatment:
 Simple fracture without displacement
( no treatment/conservative methods)
 Complex fracture ( closed reduction/ open
reduction)

12. Closed reduction
 Depressed fracture( strainght blunt elevator guided by
digital manipulation)
 Lateral displaced nasal bridge( firm digital pressure in
opposite direction)
 Impacted fragments ( asch’s forceps,walsham)
 If hematoma present then it must be drained
 Best time for closed reduction is before the appearance of
edema or after the edema subsided

13. Open reduction
 Rarely required only if the closed reduction fails
 Abnormally healed deformaities can be corrected
by open reduction( rhinoplasty or
septorhinoplasty)