I got punched in the face and head a few


Q: I got punched in the face and head a few times on Friday night. I have a lot of nose pain still, but more concerning is the constant headache. Is there a need to go into the ER or should I just keep treating it with aspirin and rest?

I got punched in the face a...-1

A:   Hello,
Thanks for the query to ATD for an opinion.

It appears from the picture to be a rather nasty blow. The peri-orbital haemorrhage , the hematoma formation on the right side around the eye is likely to have developed owing to a possible fracture of the nasal bone and the cribriform plate on the right side and also the bleeding due to rupture of emissary veins of the scalp on the right side which has trickled down along the loose connective tissue around the right eye.

If the pain in the nose is persistent and a possible continuous discharge still persists, then a fracture of the right fronto-maxillary region along with the nasal bone is a likely possibility here. Cold compresses can only give temporary relief, but the constant headache is a sign that there is a likely fracture of the frontal, nasal and maxillary bone on the right side ( more evident). This definitely needs an immediate medical attention and you should report to the ER for an immediate CT SCAN of skull and face to locate the fracture and then seek neurosurgeon's opinion.
Please visit ER soon.

I hope I have answered your query in detail here and there is no role of conservative treatment in this case here at present,
Wishing you speedy recovery,

Comments / Follow Ups

Patient: I am going to the ER now but this only happened 4 nights ago. According to my health insurance I would have to cover about $2000 of a CT Scan. I do not have any discharge at this point, and the bruise around my eye has gotten better. Is there any way to avoid the cost of a CT Scan? Even if I have a fracture on the top of my nose, isn't there a possibility it will be alright if it's not affecting my breathing?
Doctor: It is better that a ct scan is done as mild hairline fractures cannot be often seen on X-rays. The concern is not much for a nasal bone but majorly for any frontal or maxillary sinus injuries which are the probable cause of constant headache and have to be ruled out. Ifthere is no discharge then there is no csf rhinorrhoea and likely that cribriform plate is intact but still an evaluation is must. As far as the cost is concerned, its unavoidable here as CT SCAN is a must.

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