Nasal trauma

Type I Type II Type III Type IV Type V

Injury - IIA: simple Simple, Closed Open
restricted to unilateral displaced comminuted comminuted
soft tissue non fracture fracture fracture or
displaced complicated
fracture fracture
- IIB: simple
bilateral
non
displaced
fracture

Timing

<4 hours >4 hours

Elevation/ice
Reassess - 3 mm
Type II-III Type IV Axial/Coronal CT
after edema
subsides Scan
- Early Open
Reduction
- 24 hour ice - Closed - Open - Internal Fixation
pack Reduction Reduction - Consider
- Discharge - Splint - Spreader neurosurgical
- Follow up - Septal Graft involvement
as normal manipulation - Battens
- Ice for 24 - Doyle/
hours External Splint
- Heat for 7 - Septal
days Manipulation

Nasal deformity after 7 days
- Septorhinoplasty
- Controlled osteotomy
- Spread graft/battens
- External splinting
- Doyle splinting
 Frontal Sinus Fracture

Anterior Table Fracture Posterior Table Fracture

Nasofrontal Recess Injury

Anterior wall displaced Posterior wall displaced

Mild Moderate
to Severe
Yes No Yes No
(>1-2 mm) (<1-2 mm) (> 1table (< 1table
width) width)

Observe Observe
CSF Leak

No Yes Yes No
Comminution Endoscopic
Sinus Surgery
(If necessary) Observation
Comminution

None, mild, or
Severe
Moderate
Persistent
Mild Moderate
5-7 days
to severe
ORIF vs
Endoscopic
Repair Resolve
(Preserve
Frontal Sinus) Obliterate Cranialization Observe
Possible Bone Graft Frontal Sinus vs
Obliteration
 Naso Orbita Ethmoid trauma

Type I Type II Type III

Injury Injury Injury
restricted to restricted to restricted to
soft tissue soft tissue soft tissue