Nasal Fractures, Polyps, and Tumors: A Clinical Guide

Orbital Blowout Fractures

Blunt trauma can also result in a blowout fracture, which involves the fracture of the orbital floor. A significant complication is the entrapment of the inferior rectus muscle within the fracture site. Patients presenting with double vision (diplopia), difficulty looking upward, or facial numbness should be evaluated urgently with a CT of the orbits with contrast. Patients suspected of having this injury must be instructed to avoid blowing their nose.

Nasal Masses: Polyps and Papillomas

Not all nasal obstructions are traumatic; many are the result of chronic inflammation or benign growths.

Nasal Polyps

Nasal polyps are benign, mucosally covered, gray, or pale glistening masses filled with inflammatory material. They are frequently associated with allergic rhinitis and chronic rhinosinusitis. Polyps often cause nasal obstruction and a diminished sense of smell (hyposmia).

A specific clinical association known as Samter’s Triad consists of:

1. Asthma
2. Nasal Polyps
3. Aspirin allergy

Management typically begins with intranasal corticosteroids. Other options include allergen immunotherapy, oral corticosteroids (often for a short course of 6 days), surgical removal, or the use of Dupilumab.

Nasal Papilloma

Nasal papillomas are rare, wart-like, or "cauliflower-shaped" tumors located on the lateral nasal wall. These tumors are caused by the Human Papillomavirus (HPV). While benign in their initial presentation, they carry a risk of malignant transformation into Squamous Cell Carcinoma (SCC). Management requires complete surgical excision and regular follow-up due to the risk of recurrence.

Malignant Sinus Tumors

Malignancy in the sinonasal region must be considered, especially when symptoms are unilateral or progressive.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the most common malignancy of the sinuses and the nasopharynx. Early symptoms are often nonspecific and can easily be mistaken for common sinusitis or rhinitis.

As the tumor progresses, clinicians should look for "red flag" symptoms:

• Unilateral nasal obstruction.
• Otorrhea (ear discharge) or otitis media.
• Recurrent hemorrhage (epistaxis).
• Proptosis (bulging of the eye).
• Expansion of the cheek or ill-fitting dentures.

Diagnosis requires a tissue biopsy and an MRI to determine the full extent of the tumor. Treatment is highly individualized based on the type and stage of the cancer, involving surgery, radiation, or chemotherapy.

Summary Table of Sinonasal Pathologies

Exam Tip: If a question describes a patient with recent facial trauma and a "boggy" septum, the answer is almost always septal hematoma, and the next step is emergent ENT referral to prevent a "saddle nose" deformity.