Management of Nasal Fractures in Children

Division of Otolaryngology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, California 94304. Crepitus of the nasal bones is the sine qua non of a nasal fracture, and should always be searched for. At the same time, it is equally important to determine by palpation the stability of the nose. Other frequent findings associated with nasal fractures are local edema, epistaxis, periorbital ecchymoses and nasal skin lacerations. Concomitant injuries to the facial bones, orbit or eyeball are not uncommon, and should always be ruled out when the nose has been injured. X-rays are advisable whenever a nasal fracture is suspected. These should include &dquo;cone down&dquo; right and left lateral nasal views and a base view of the nose, and also facial views when a facial fracture is suspected. Generally speaking, x-rays contribute much less than a good clinical evaluation. For example, in one reported series of proven nasal fractures, nasal x-rays were negative in 47%.~ On the other hand, x-rays will occasionally disclose an undisplaced fracture which could not be otherwise diagnosed. Previous nasal fractures, unrelated to the immediate injury, sometimes show up on x-rays. An x-ray view in the Water’s position or a straight AP projection may be informative, since the position of the bony septum can be seen on both views. Taking frontal and lateral 35 mm color photographs can be very helpful, when a fracture is present, for comparison later, after