Nose

INTRODUCTION

NASAL FRACTURES

Fractures of the nose can occur in isolation or combined with fractures of the maxilla or the zygomatic arch. Always check for a compound fracture or head injury and if present leave alone and refer.

Practice tips

• X-rays are generally unhelpful unless excluding other facial skeletal injuries

• If a deformity is present, refer the patient within 7 d, ideally from days 3–5

• Skin lacerations, i.e. compound fracture, usually require early repair

• The optimal time to reduce a fractured nose is ~10 d after injury; the window period before union is 2–3 wks

• Closed reduction under local or general anaesthetic is the preferred treatment

• Open reduction is more suitable for bilateral fractures with significant septal deviation: bilateral fractures with major dislocations or fractures of the cartilaginous pyramid

NASAL POLYPS

These are round, soft, pale pedunculated outgrowths arising from the nasal or sinus mucosa. They are basically prolapsed congested oedematous mucosa, described by some as ‘bags of water’. They occur in patients with all types of rhinitis but esp. allergic rhinitis. Symptoms include nasal obstruction and loss of smell.

Treatment

• Medical ‘polypectomy’: use oral steroids, e.g. prednisolone 50 mg/d for 7 d plus steroid nasal spray; continue for at least 3 mths

• Antibiotics for purulent nasal discharge

• Surgery—refer for procedure which can be complex

NASAL VESTIBULITIS

Includes:

• Low-grade infection and folliculitis → pain, crusts and bleeding esp. if ‘picking habit’. Treat with bacitracin or mupirocin oint. for 14 d

• Furunculosis—usu. S. aureus, may cause spreading cellulitis. Treat with minimal handling, hot soaks, systemic antibiotics (e.g. dicloxacillin), but take swabs from the vestibule

• Fissures: painful fissures develop at the mucocutaneous junction. Treat with petroleum jelly (Vaseline) to keep moist, hot compresses and an antibiotic or antiseptic ointment if nec.

OFFENSIVE SMELL FROM THE NOSE

Ensure no foreign body present.

• Mupirocin 2% nasal ointment—instil bd or tds for 5 d (esp. if S. aureus in nares) or

• Kenacomb ointment—instil 2 or 3 times/d

RHINOPHYMA

This disfiguring swelling of the nose is due to hypertrophy of the nasal sebaceous glands. There is no specific association with alcohol. More common in men >45 yrs. May be associated with rosacea.

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