Nasal fracture/septal haematoma

Background: Nasal fractures are the most common bony facial injury. Patients often present soon after the injury. However, often, there is significant bruising and swelling evident, making if difficult to determine if a nasal fracture is present or not. Any patient with a suspected fracture should be referred for assessment as nasal manipulation under local anaesthetic can be easily performed in the outpatient clinic 10-14 days from the injury. However, if this time period is missed, then nasal manipulation under local anaesthetic may not be successful and a much more involved operation of septorhinoplasty (nose job) may be required at significant cost to the NHS and significant delay to the patient for treatment.

One of the most significant problems to exclude early following the injury is a septal haematoma (can be unilateral or bilateral) – if left untreated this can result in septal perforation or a septal abscess which can result in intracranial infection if unrecognised.

How to assess:

Examine the nasal septum with a light / otoscope

If a swelling evident on the septum, feel it with a gloved finger

If it is hard or tender, it is likely a deviated septum or the patients inferior turbinate

If it is fluctuant and non-tender, then it is likely a septal haematoma

Referral guidance:

Refer any suspected cases of septal haematoma to ENT as an emergency for same-day review

Refer any patient with suspected nasal fracture to ENT on an urgent basis for Nurse-led Nasal Fracture clinic review