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Current Evidence
To target the use of CT among children with facial trauma, a few studies have
identified clinical predictors of orbital fracture. These studies have identified that
orbital fractures requiring operative intervention are uncommon in the absence of
orbital tenderness, swelling, ecchymosis, nausea/vomiting, or painful extraocular
movements.
Studies suggest that early repair (within 24 to 48 hours) of orbital trapdoor
fracture and release of the entrapped muscles may help avoid muscle ischemia
and fibrosis, and result in better functional recovery. A few studies have also
demonstrated that corticosteroids may decrease swelling and hasten resolution of
diplopia among patients with limitation of extraocular movement.

Nasal Fracture
Goals of Treatment
The primary goals in treatment of nasal fractures in the emergency setting are
immediate recognition and drainage of septal hematoma, and in children,
reduction of nasal fractures with deformity within 7 days.
CLINICAL PEARLS AND PITFALLS
Nasal fractures may be difficult to detect clinically because of significant
swelling.
Septal hematomas require urgent incision and drainage to avoid
necrosis of the avascular septal cartilage.
Patients with nasal deformity 4 to 5 days after injury require urgent
consultation with a subspecialist to restore anatomic alignment.
Clinical Considerations
The nasal bones are among the most commonly fractured bones of the facial
skeleton because of their prominent location on the face. Nasal fractures may be
difficult to detect because of significant swelling associated with such injuries.
Imaging is rarely needed in the emergent care of children with nasal trauma
because, in most cases, it does not contribute to subsequent care and
management. Most nasal injuries can be managed as an outpatient, and evaluation

after the swelling subsides dictates the need for further intervention.
Two particular nasal injuries that deserve specific comment are the intractable
nosebleed and septal hematomas. Because of the rich vascular network in the