Management of Deep Nasal Laceration with Exposed Cartilage and Mild Fracture

Initial Assessment and Imaging

The American College of Radiology recommends CT maxillofacial imaging for comprehensive evaluation of nasal trauma with deep lacerations showing cartilage, as it provides superior delineation of osseous and soft tissue structures and can detect subtle nondisplaced fractures 1, 2, 3
Ultrasound may be considered as an adjunct for evaluating isolated nasal bone fractures with high sensitivity (90-100%) and specificity (98-100%), particularly for nondepressed fractures of the nasal bridge 1
Plain radiographs have limited diagnostic value in nasal trauma with sensitivity ranging from 53-82% and generally do not alter management decisions 1, 3

Preservation of periosteal and mucosal attachments is crucial to minimize destabilization of the nasal framework 4
Camouflaging techniques using cartilage grafts may be considered for residual deformities after healing 5, 6

Prophylactic antibiotics are recommended for deep nasal lacerations with exposed cartilage to prevent infection 7
If infection is suspected or present, obtain deep tissue cultures (minimum of five samples) for targeted antibiotic therapy 7
Avoid swab cultures due to low sensitivity and high risk of contamination 7
Antibiotics should be administered immediately after sampling in suspected infection 7

Nasal airway obstruction due to septal deviation or mucosal edema may occur 5, 6
Cosmetic deformities that may require secondary rhinoplasty after complete healing may occur 5, 6

Nasal saline irrigation is recommended to keep the nasal passages clean and prevent crusting 8