Criteria for immediate referral
Refer patient to hospital immediately if symptoms suggest:
- septal haematoma:
- swelling of the septum seen on looking up the nose - untreated, leads to necrosis of cartilage, collapse of the bridge and saddle nose
- other facial or skull fracture:
- diplopia - blowout fracture of the orbit
- limited extraocular movement (1)
- numbness of cheek - fracture of the malar bone
- malocclusion of teeth - fracture of the jaw
- trismus (spasm of V) - motor disturbance of the trigeminal nerve
- CSF rhinorrhoea - fracture of the temporal bone
- anosmia - shearing of the olfactory nerves
- subcutaneous emphysema (1)
- mental status changes (1)
Reference:
(1) Corry J. Kucik. Management of acute nasal fractures.Am Fam Physician 2004;70:1315-20
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