Treatment for Trauma to the Bony Bridge of the Nose

Initial Assessment and Imaging

• The American College of Radiology recommends assessing for life-threatening complications first, checking for airway compromise from hemorrhage, soft-tissue edema, or loss of facial architecture 2
• The American College of Radiology suggests screening for associated injuries, evaluating for intracranial injuries, other facial fractures, and cervical spine injuries, as 68% of maxillofacial trauma patients have associated head injury 2, 3

Diagnostic Imaging

• The American College of Radiology recommends CT maxillofacial imaging as the preferred modality for nasal bridge fractures, providing superior detection and characterization compared to plain radiographs 1, 4
• The American College of Radiology states that plain radiographs have limited value, with accuracy only 53-82% and rarely alter management decisions 1, 4

Treatment Algorithm

• The American College of Radiology suggests septal correction must precede nasal bone realignment if septal deviation is present 1
• The American College of Radiology recommends positioning the septum into midline using transverse root osteotomy for complex fractures with septal deviation 1

Critical Contraindications and Pitfalls

• The American College of Radiology indicates that naso-orbital-ethmoid fractures can result in telescoping of the nose and require subspecialist management to prevent enophthalmos, telecanthus, lacrimal obstruction, and ptosis 3

Post-Treatment Management

• The American College of Radiology recommends nasal saline irrigation to keep nasal passages clean and prevent crusting 4
• The American College of Radiology suggests monitoring for nasal airway obstruction from septal deviation or mucosal edema 4

Pain and Infection Management

• The American College of Radiology recommends prophylactic antibiotics for deep lacerations with exposed cartilage to prevent infection 4