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Performing the initial physical examination and history is a critical step. Posttraumatic edema, preexisting nasal deformity, or a discrete septal fracture may complicate the physical examination and may lead to unrecognized acute deformity. First, external evaluation to determine nasal deviation followed by an internal examination with proper lighting and a nasal speculum should be performed on all patients who present to the emergency room or clinic. On physical examination, it is important to palpate the nasal bones to identify areas of collapse and/or asymmetry. Tenderness on palpation may help to elucidate the age of a fracture, as patients may present with new fractures following a his