Nasal bone fractures are the commonest type of bony facial injury causing aesthetic deformity. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose, by comparing pre- and post-treatment nasal aesthetics. Thirty-two patients (26 men and 6 women) underwent aesthetic assessment prior to treatment of the injury by closed nasal manipulation, 7 to 10 days after the initial injury. Standard facial aesthetic photographic assessments were performed prior to and following manipulation. Assessment involved measurement of standard nasal aesthetic parameters. In the nasal trauma cohort, the main anomalies in nasal aesthetics were nasal deviation and differences in the nasal aesthetic profile. Nasal fracture manipulation successfully reduced deviation from an average of 35° pre-manipulation to an average of 9° post-manipulation.

Nasal foreign bodies are common in young children and are typically the result of intranasal placement by the child. The authors report a case of an extranasal foreign body in an adult, which presented as a nasal fracture following trauma to the nose. This uncommon presentation, previously unreported in the literature, highlights the importance of careful history taking in cases of nasal trauma and of thorough wound exploration if any penetrative injury is found.

A double-blind randomized prospective case-control pilot study was performed to assess tissue distortion caused by the infiltration of local anaesthetic to the dorsum of the nose and to see if this was altered by the addition of hyaluronidase. Forty patients undergoing nasal manipulation for fractured nasal bones were randomized to receive either 4 ml of twoper cent lignocaine and adrenaline 1:200000 or 4 ml of two per cent lignocaine and adrenaline 1:200000 with 1500 IU hyaluronidase, which was infiltrated subcutaneously over the nasal dorsum.One surgeon using a standardized technique performed the nasal infiltration. Other outcome measures were ease of manipulation, adequacy of the reduction, patient satisfaction with cosmesisand patient analgesia requirements. There were trends for decreased tissue distortion and improved ease of manipulation in the hyaluronidase group. Larger trials are required to confirm these results.

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 U.K.-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 ressure 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.

Chondromyxoid fibroma is a rare benign tumour whose histological appearance may easily be misinterpreted as chondrosarcoma. It has a tendency to recur locally unless completely excised. A rare case of the tumour affecting the nasal bone with extension into the frontal and ethmoidal sinuses and impingement on the cribiform plate is presented. Complete excision was achieved any the craniofacial resection approach.

We present four patients complaining of neuralgic pains across the nasal bridge following trauma, who were successfully treated by division of the external nasal nerve. We believe it is a useful treatment in selected cases.