A double-blind randomized prospective case-control pilot study was performed to assess tissue distortion caused by the infiltration of local anaesthetic to the dorsum of the nose and to see if this was altered by the addition of hyaluronidase. Forty patients undergoing nasal manipulation for fractured nasal bones were randomized to receive either 4 ml of two per cent lignocaine and adrenaline 1:200000 or 4 ml of two per cent lignocaine and adrenaline 1:200000 with 1500 IU hyaluronidase, which was infiltrated subcutaneously over the nasal dorsum. One surgeon using a standardized technique performed the nasal infiltration. Other outcome measures were ease of manipulation, adequacy of the reduction, patient satisfaction with cosmesis and patient analgesia requirements. There were trends for decreased tissue distortion and improved ease of manipulation in the hyaluronidase group. Larger trials are required to confirm these results.