Question:  A 27-year-old male is struck in the nose with a foul ball at a softball game.  Evaluation in the emergency department demonstrates marked tip deviation to the left and instability of the bony nasal pyramid.  Even after several doses of pain medication, the patient reports significant pain at the nasal tip and reports that he cannot breathe through his nose at all.  Anterior rhinoscopy reveals widening of the nasal septum with a dark red fluid collection.  If left untreated, what complication may this patient experience?   [Answer will be posted with next week's new question]

Answer to last week's question, Dry it Up (June 29, 2015): 

Botulinum toxin prevents presynaptic release of acetylcholine.  The medication is injected into salivary glands where the toxin diffuses into cholinergic synapses.  Blockade of transmission acts as an anticholinergic, decreasing release of saliva.