Management of nasal injuries: a postal questionnaire survey of U.K. ENT consultants

Abstract

Nasal injuries are one of the commonest conditions seen in ENT out-patients. There is no uniform policy or protocol for the management of this condition. A postal questionnaire was sent to all UK-based ENT consultants. The aim of this study was to ascertain current practice in the management of this common problem. We were also interested to know if consultants believed that the septum should be addressed and dealt with at the same time as manipulation to improve cosmetic and functional results. Manipulation of nasal bones without anaesthesia, under local anaesthesia, and general anaesthesia with digital pressure or using instruments are all practised. The digital pressure under general anaesthesia with use of septal and nasal forceps, if needed, is practised by the majority of consultants (55.8 per cent). Only a minority considered the role of the septum to be important in the initial management of the patient.

Optimal timing for nasal fracture manipulation—Is a 2‐week target really necessary? A single‐centre retrospective analysis of 50 patients

“…There remains a great deal of conflict between clinicians and institutions regarding optimum timing for nasal fracture manipulation to achieve the best aesthetic and functional outcomes and minimise the need for future corrective surgery . Some studies have reported greater patient satisfaction with earlier reduction and proportionately worse results as the injury‐to‐surgery interval increases .…”

“…Current management convention largely stems from anecdotal reports and dated research, with a paucity of any high level evidence to support it . Additionally, there is no solid consensus between centres or clinicians . Despite this, the dogma surrounding nasal fracture management persists and in our experience, some centres have been known not to offer manipulation to patients whose injuries occurred more than 2 weeks previously.…”

Acute nasal fracture management: A prospective study and literature review

“…A postal questionnaire study conducted among UK‐based ENT consultants showed that 55.8% practiced digital pressure under GA with use of septal and nasal forceps if needed. At the time of manipulation, 34.8% would assess septum and consider septoplasty; 25.6% would consider septorhinoplasty; and surprisingly, only 38.2% would arrange routine follow‐up …”

Manipulation of nasal fractures with local anaesthetic: A ‘How to do it’ with online video tutorial

“…Despite evidence for the benefit of local anaesthesia (LA), 3–7 nasal fractures are still most commonly reduced under GA 8 . Many factors contribute to this, including lack of familiarity with nasal LA and a lack of trained practitioners at the front line of medicine such as emergency doctors and ear, nose and throat surgeons.…”