The majority of patients present to Accident & Emergency at the time of injury. Mostly there will be significant swelling making assessment difficult.
Parents will be asked to wait for this to settle and represent to A&E in 5 to 7 day’s time, if they feel the nose is deformed. They will usually be reassessed by A&E and if there is deformity or doubt, will be referred to ENT for further assessment and consideration of manipulation. This can be undertaken in RHCYP or SJH (if the child is healthy and over 3 years of age). Older children can be manipulated under local anaesthetic whilst younger ones will need a general anaesthetic.
Ideally, if nasal manipulation is required, it will be performed within two weeks of the injury and a maximum of three weeks post injury (the longer the delay the decreased chance of successful outcome).
We do not usually undertake nasal manipulation after this timeframe. Should there be significant nasal deformity with nasal obstruction, a septorhinoplasty can be considered after puberty in the adult ENT service.
C.M & G.T 24-04-23
If patients present to GPs with bony nasal deviation within 2 weeks post nasal injury, please call the ENT doctor on call via RHCYP switchboard in order for appropriate ENT review to be organised.
If the patient presents more than two weeks post injury, there is not enough time to arrange nasal manipulation. A routine ENT referral can be considered, but intervention will not be considered until adulthood, so is probably futile.
General Practice Management
Assess
- General assessment according to injury pattern
Nose
- Septal haematoma
- Bony deformity
- Swelling
Management as in A&E in introduction
