Nasal Bone Fracture Management

Referral Guidelines

The American College of Radiology emphasizes that complex midface fractures require subspecialist management due to involvement of multiple facial bones and potential for severe functional and cosmetic complications 1, 2
Refer isolated nasal bone fractures to ENT/Otolaryngology for closed reduction with or without septal correction, but immediately refer to maxillofacial surgery if there are associated complex midface fractures (naso-orbital-ethmoid, Le Fort, or zygomaticomaxillary complex injuries) 3, 2
ENT specialists routinely manage isolated nasal bone fractures and perform closed reduction with or without septoplasty 2
Septal correction must precede nasal bone realignment when septal deviation is present 3

Septal hematoma requires urgent ENT referral for drainage to prevent septal necrosis 4
Open fracture with exposed cartilage requires urgent ENT referral 4
Cerebrospinal fluid leak (suggests cribriform plate involvement) requires urgent neurosurgical consultation 4, 2
Persistent epistaxis despite conservative measures requires urgent ENT referral 4

Order CT maxillofacial imaging to characterize fracture pattern and identify extension to adjacent structures 2
Do not order plain nasal radiographs (only 53-82% accuracy, does not alter management) 5, 4
Screen for intracranial injury as 68% of maxillofacial trauma patients have associated head injury 2
Assess for other facial fractures (zygomatic, maxillary, frontal) using CT 4

Instruct patient to lean forward and pinch soft part of nose for 15 minutes to manage epistaxis 4
If bleeding persists, spray 2 sprays of oxymetazoline (65-75% resolution rate) 4
Prescribe regular paracetamol unless contraindicated for pain management 4
Apply ice for first 48-72 hours to reduce swelling 4
Use humidification and saline nasal spray for symptomatic relief 4
Instruct patients to avoid nose-blowing, contact sports, and nasal manipulation 4

The American College of Radiology recommends that patients with nasal bone fractures who also have complex midface injuries (e.g., naso‑orbital‑ethmoid, Le Fort, or zygomaticomaxillary complex fractures) receive an immediate referral to maxillofacial surgery to prevent severe functional and cosmetic complications. 6

The American College of Radiology notes that untreated complex midface fractures, particularly naso‑orbital‑ethmoid injuries, can result in telecanthus, enophthalmos, lacrimal drainage obstruction, and eyelid ptosis, highlighting the need for management by appropriate subspecialists. 6