Intended for healthcare professionals

Practice Practice Pointer

Acute nasal injury

BMJ 2014; 349 doi: (Published 18 December 2014) Cite this as: BMJ 2014;349:g6537
  1. A Razavi, academic foundation year 1 doctor1,
  2. A Farboud, ear, nose, and throat specialty registrar1,
  3. R Skinner, general practitioner2,
  4. K Saw, ear, nose, and throat consultant1
  1. 1Singleton Hospital, Swansea SA2 8QA, UK
  2. 2Bryntirion Surgery, Bargoed, UK
  1. Correspondence to: A Razavi ahmedrazavi786{at}
  • Accepted 14 October 2014

The bottom line

  • After ensuring there is no airway and cardiorespiratory compromise, a careful clinical assessment should include preceding events, accompanying symptoms (such as extent of epistaxis, deformity), and damage to adjacent structures

  • Refer immediately to the emergency department if the patient has persistent epistaxis, nasal septal haematoma, persistent rhinorrhoea, visual disturbance, suspected facial fracture, severe headache or neck pain, or neurological signs

  • Radiographs are not indicated in most cases

  • Refer people with nasal fractures and obvious nasal deformity but no other injuries to the ear, nose, and throat (ENT) department within 7-14 days

Nasal injuries are a common presentation to emergency departments and primary care settings. Acute nasal injury often occurs as a result of trauma and can lead to epistaxis, nasal fracture, or even nasal septal haematoma. Epistaxis accounts for 33% of all admissions to emergency ear, nose, and throat (ENT) departments and head and neck surgery facilities, and it can require cautery or packing.1 Occasionally surgical intervention might be required. Nasal fractures are the third most common type of fracture and the most common type of facial fracture.2 3 The nasal spine lengthens and begins to ossify at around 3 years of age, completing its growth and ossification during puberty.4 Nasal fractures are therefore predominantly seen in the adult population. The incidence of nasal fractures is rising in the United Kingdom, especially among girls and women, and is most commonly caused by assault.5 Other forms of trauma, such as sporting injury, account for most other cases. Nasal septal haematomas are rarer, but require urgent evaluation to prevent nasal deformity.

A recent study showed that after clinical teaching to junior emergency doctors, appropriate nasal examination and documentation rates increased from 30% to 97%,6 and the rate of unnecessary facial and nasal radiographs performed also decreased from …

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