A fractured nose is a common injury. It can lead to both nasal obstruction and nasal deformity.

For the first three weeks following a nasal fracture (closer to two weeks in children) the nasal bones remain mobile and can often be reduced removing the need for further treatment at a later date. The best time to reduce a nasal fracture is at the time of the injury. Within a very short time frame however swelling and bruising develops, which makes assessment and treatment of the fracture difficult. The best time therefore to see nasal fractures is between one and two weeks following the injury. By this time the swelling has reduced enough to see if the deformity requires further treatment, but it is also early enough for the bones to be simply manipulated. Nasal fracture reduction can usually be achieved under local anaesthetic but on some occasions general anaesthesia may be employed.  We are currently unable to provide this service in the rooms due to ACC requirements.  Please refer patients to the fractured nose clinic via the acute on call Registrar at Auckland City Hospital.   Patients should be referred for assessment at the time of their initial presentation but inform them they will be seen when the swelling has reduced, usually between one and two weeks.    

X-rays are not required for nasal fractures and do not alter the management. If the nose is deformed following an injury the nose can be reduced irrespective of the X-ray findings. Similarly if there is no deformity, no reduction will be required, irrespective of the X-ray findings.

The success rate of nasal fracture reduction is probably in the region of 50%. The commonest reason for failure is deviation of the nasal septum which is not easily corrected by simple manipulation. If the reduction is unsuccessful, either cosmetically or functionally, or if reduction is not possible because the two week window of opportunity is missed, then the patient becomes a candidate for a septorhinoplasty.

ACC funds treatment of nasal fractures but not in the acute phase .  If surgical correction is required I am happy to see nasal fractures for appropriate assessment and treatment.

PAEDIATRIC NASAL FRACTURES

Nasal fractures also occur in children.  However acute intervention is less frequently required or beneficial in the paediatric age group.   Any intervention that is appropriate requires a general anaesthetic.  In addition nasal fractures tend to fuse or heal earlier than in adults.  Referral therefore is time sensitive from the point of referral to treatment under general anaesthesia.  I therefore recommend a referral to the acute ORL Registrar at Starship Hospital for all nasal fractures in children 12 and under.  

Non acute correction of subsequent deformities such as septoplasty and septorhinoplasty are also much less frequently undertaken in the paediatric age group.   In general we endeavour to wait until facial growth is complete usually after the age of 14 in females and 15 or more in males.  Clearly there will be exceptions and I am happy to see non-acute paediatric patients post nasal trauma  to discuss the treatment options with their parents.