Nasal Fracture

Nasal fracture is a clinical diagnosis and there is no evidence that immediate reduction of a displaced fracture, practiced in some centres, is any better than delayed assessment and reduction [18].

However, displaced fractures must be reduced before 14 days as attempted closed reduction beyond this time may be impossible [19].

The following explain the management of specific complications of nasal injury:

Septal haematoma

Septal haematoma is a rare problem but is more common in children due to the relative lack of bone in the nose which is softer, and therefore more easily deformed.

If identified, a patient with a septal haematoma must be referred urgently to an otolaryngologist for drainage and nasal packing.

Traumatic epistaxis

Traumatic epistaxis is common in nasal fracture and, although occasionally severe, is usually self-limiting.
It can be managed in a similar way to a non-traumatic nosebleed – for a more comprehensive account of the management of epistaxis see the session Acute Epistaxis.
If CSF rhinorrhoea is confirmed, the patient should be referred immediately to an otolaryngologist for further assessment.

Learning bite

Uncontrolled epistaxis, CSF rhinorrhoea and septal haematoma are all indications for urgent otolaryngology referral in nasal injury.


The management of nasal injuries varies greatly across the UK [20] and therefore a suggested flow chart is illustrated below: