Update on the management of nasal trauma

The nose is the most prominent part of the face and is therefore most susceptible to injury. Depending on the severity, the injury may involve only the soft tissues of the nose, including the skin, subcutaneous tissue, nasal muscles and nasal mucosa, or it may involve fractures of the cartilage and bones of the nose. The nose, as a set of soft tissues and bones, plays an important role both functionally and esthetically. Repairing the esthetic of the nose to the pretrauma form has become just as important as repairing function. This article aimed to review and summarize the current literature on the clinical and surgical management of nasal trauma in adults and children, with particular attention to patient characteristics, management strategies, and outcomes in terms of the need for secondary surgery and patient satisfaction. Nasal soft tissue injuries can be complicated, but, with hypervigilance of the surgeon and an understanding of soft tissue trauma of the nose, many complications can be avoided, and an excellent result can be obtained. There are differences of opinion regarding timing of the treatment of nasal fractures. If a patient is seen shortly after trauma, before significant edema develops, immediate treatment may be indicated. Other indications for immediate treatment include the presence of concomitant lacerations with exposure of the underlying skeletal or cartilaginous elements or the presence of a septal hematoma that requires immediate drainage. It is thought that reduction in children should be done earlier than adults, as osteogenesis is faster in children. To date, the management of nasal trauma represents a still open and dynamic field that needs more definition and standardization. There are several reasons for this. The otolaryngologist, as an expert of the overall nasal-facial pathology, may represent the reference, with expertise in facial plastic surgery, as skilled in the management of nasal trauma with related complications and in the reconstructive phase.