A: Due to its location, prominent and rather fragile structures, and sometimes provocative demeanour, the face is the subject of frequent mechanical trauma resulting in underlying bony injury. Facial trauma commonly results from motor vehicle accidents, altercations, contact sports, domestic accidents, and work-related injuries. The nasal bones are the bones most often fractured in facial injuries.
The common symptoms and signs of blunt nasal trauma include nosebleed or epistaxis, pain, swelling, deformity, tenderness and crepitus (cracking or popping sensations) over the dorsum (bridge) of the nose. In addition, one often has nasal congestion and obstruction due to the presence of blood clots, swelling, and possibly a deflection of the septum.
Blunt nasal trauma is evaluated through examination and selective radiological investigations. It is important to distinguish nasal contusion from simple fractures limited to the nasal bone and complicated fractures involving the nasal septum and other facial bones. Nasal bone X-rays or CT scans will confirm the diagnosis. Nasal septal fractures may be associated with a haematoma and require urgent treatment. An untreated haematoma may result in infection, tissue loss and collapse of the nasal dorsum.
Simple nasal bone fractures without cosmetic deformity may be allowed to heal spontaneously. This process may require up to two to four weeks. Symptomatic treatment and protection of the fracture may suffice. However, should cosmetic deformity or nasal obstruction exist, intervention is required. Fractures in adults usually remain malleable for three to five days after injury and are amenable to closed reduction using a combination of topical and local anaesthesia, and immobilisation with intranasal packing and an external splint. A nasal septal haematoma will require drainage through an intranasal incision. Significant nasal septal fractures may be similarly approached and repaired via an intranasal approach.
You should consult an ENT surgeon for an opinion.