Which internal nasal exam findings are characteristic of nasal fractures?

Updated: Dec 06, 2018
  • Author: Samuel J Haraldson, MD; Chief Editor: Craig C Young, MD  more...
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Internal examination

  • Acute edema may hide deformities; however, a careful search for intranasal injury must take place.

  • Adequate lighting must be available, and the patient should be placed in a comfortable, slightly reclined position. Bleeding can be controlled with topical cotton pledgets soaked in vasoconstrictors, such as 0.25% phenylephrine (Neo-Synephrine [Bayer HealthCare, Morristown, NJ] is also available as a spray) or 4% cocaine, which also provides anesthesia. Retained blood clots should be removed with suctioning or swabbing.

  • The clinician should search for any deformity or septal hematoma; however, septal deviation does not automatically determine fracture. An estimated 33-50% of the population normally has a septal defect.

Manipulation: A cotton-tipped swab should be placed in each naris up to the septum to check for deformity and mobility.

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