Manipulation of nasal fractures under local anaesthetic: a convenient method for the Emergency Department and ENT clinic

Emerg Med J. 2010 Jun;27(6):473-4. doi: 10.1136/emj.2009.081695. Epub 2010 May 13.


Background: Nasal fractures are the commonest facial fracture. They can cause morbidity in terms of nasal obstruction and cosmesis. They can be treated by simple external digital manipulation, provided they are seen and assessed in a timely fashion. This manipulation is commonly done under general anaesthetic (GA), which utilises precious resources and may cause delays in treatment.

Summary of evidence for proposed method: A recent comprehensive systematic review has shown local anaesthetic (LA) to be comparable to GA in terms of cosmesis, airway patency and patient acceptability. The experience for the patient is akin to that of a dental filling, and can be made more painless with the use of topical anaesthesia.

Proposed method: In the current age of evidence-based medicine and drive for cost-effective management decisions, it is thought that LA manipulation may offer a superior option to GA. A simple method for manipulation under LA is presented that can be done in the Emergency Department.

MeSH terms

  • Anesthesia, Local*
  • Fractures, Closed / therapy*
  • Humans
  • Manipulation, Orthopedic
  • Nasal Bone / injuries*
  • Skull Fractures / therapy*