• Obtain informed consent
• Consider taking “before” and “after photos for medical record if patient agreeable
• Above: See Video - Closed Reduction Nasal Fracture

Step-by-Step Instructions

1. Local vs. regional vs. procedural anesthesia
   • Option for procedural sedation, but closed reduction can be performed under local anesthesia in majority of patients
   • Nasal cavity should be prepped with cotton pledgets moistened in a solution with topical anesthetic and vasoconstrictor
   • Option for regional anesthesia with infraorbital nerve block
2. Elevate depressed nasal bone using scalpel handle
   • Ensure appropriate depth by placing the handle outside of the nose, and measuring a depth approximately at the level of the medial canthus
   • Place the index finger against the scalpel handle to ensure it cannot be advanced too far superiorly

3) Use opposite hand to manually displace pyramid to midline

4) Carefully reposition until ideal alignment

5) After reduction, place adhesive strips over the skin of the nasal dorsum or use an external splint that conforms to the patient’s nose.

• If nasal bones comminuted, may require intranasal packing first