Resident Manual of Trauma to the Face, Head and Neck

CHAPTER 4: Midfacial Trauma

5. Splaying/Widening of Nose (Figure 4.13) 6. Widening of Nasal Root, or Telecanthus y y May suggest orbital/ethmoid fracture, especially when acute swelling has subsided. 7. Nasal Function Alteration, Causally Related to Occasion of Trauma y y New, fixed nasal obstruction.

y y Often, but not always, unilaterally. y y New olfactory deficit (anosmia). 8. Examination y y Attend to associated injuries, as applicable (e.g., cervical, cranial, facial). y y Examine eyes/orbits (pupils, globes, extraocular motion, visual acuity). y y Narrow consideration to nose when other injuries are identified or excluded. y y Preferably, conduct examination in the otolaryngology clinic with availability of good lighting and nasal examination instruments. y y Establish nature of external deformity, as above. y y Palpate for bony stepoffs, displacements, discontinuities. y y Palpate for mobility of fractured segments, comminution. y y Identify/characterize nasal soft tissue (skin) lacerations/avulsions. y y Apply anterior rhinoscopy, with added nasal endoscopy as required, to identify presence of: •• Septal deformities, both cartilaginous and bony, especially stepoffs/telescoping deformities. •• Septal haematoma. •• Septal perforations. •• Nasal lining lacerations. •• Bleeding points, if continued acute bleeding is present. •• Overall nasal airway patency. 9. Radiographic Studies, Including CT y y If referred from the emergency room or a minor emergency clinic, patient may arrive with studies in hand. Figure 4.13 Splaying/widening of the nose.

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Resident Manual of Trauma to the Face, Head, and Neck