Management of Non-Displaced Nasal Fractures

Initial Evaluation

The American College of Radiology recommends excluding associated facial fractures (zygomatic, maxillary, frontal) in patients with non-displaced nasal fractures 1, 2
Evaluate the presence of associated septal deviation, as septal injuries are responsible for post-traumatic nasal deformities and obstruction 3
Check for the absence of open wounds or exposed cartilage 4

The American Academy of Otolaryngology-Head and Neck Surgery suggests using topical vasoconstrictors (oxymetazoline) for epistaxis, with a 65-75% resolution rate of bleeding 5
The American College of Radiology recommends prescribing regular paracetamol for pain management, unless contraindicated 6
Use opioids with caution, particularly in elderly patients with renal dysfunction 6
Avoid non-steroidal anti-inflammatory drugs in patients with renal dysfunction 6

Apply ice to reduce swelling in the first 48-72 hours, although the exact duration is not specified in the cited references
Use humidification and saline nasal spray to maintain humidity and promote healing 5

Instruct patients to avoid further trauma (no vigorous nose-blowing, avoid contact sports) and to avoid touching or manipulating the nose 5

Refer immediately to an otolaryngologist if there is a septal hematoma, open fracture with exposed cartilage, significant nasal deformity, or persistent epistaxis despite conservative measures 3, 4, 5
Suspected cerebrospinal fluid leak requires urgent referral 1

Instruct the patient to lean forward and pinch the soft part of the nose for at least 5 minutes, continuing for a full 15 minutes if bleeding slows, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 7
If bleeding persists despite these measures, spray 2 sprays of oxymetazoline in the bleeding nostril and continue holding for 5 minutes, achieving 65-75% resolution of bleeding, as per the American Academy of Otolaryngology-Head and Neck Surgery 7
Provide clear instructions on preventive measures, such as eliminating digital trauma and using proper nasal hygiene, as advised by the American Academy of Otolaryngology-Head and Neck Surgery 7
Advise patients on anticoagulation not to stop their medications without consulting the prescribing physician, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 7

Routine imaging is NOT indicated for isolated nondisplaced nasal fractures without clinical deformity, according to the American College of Radiology 8, 9
Plain radiographs have limited diagnostic value with only 53-82% accuracy and should not be used, as stated by the American College of Radiology 8

Document the outcome of intervention or transition of care within 30 days for quality assurance and to identify any delayed complications requiring further management, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 7