Management of trauma to the nasal bones and septum

A thorough history and physical should be part of any nasal fracture evaluation. Visual inspection, manual palpation and anterior rhinoscopy are essential. A thorough exam of the septum is also necessary to rule out septal hematoma and to properly access any septal deformity. Management of nasal injuries frequently requires individualization and an understanding of the patient's overall condition, associated injuries, age, and likelihood of reinjury. While traditional closed manipulation may be appropriately indicated in simple nasal fractures, it may frequently produce suboptimal results in more complex fractures or noses with pre-existing deformity. Practitioners should be prepared to perform reduction using either the described modified open or open technique.