Nasal fracture with and without displacement - signs, treatment, surgery

General concept

Nasal fracture in a child - photo:

A fracture is a violation of the integrity of the bone with the subsequent separation of its component parts. A fracture can occur as a result of physical force, a blow, or an inflammatory process, although the latter option is quite rare.

When a fracture occurs, pathological mobility of the bone and its parts occurs, a characteristic crunch is heard, nearby tissues swell, and sharp pain occurs.

Depending on the degree of the fracture and its type, some characteristic symptoms of the pathology may be absent , while others, on the contrary, will be more intense.

First aid for a broken nose

The main thing in this case is not to do harm. First, it is important to calm the victim, because he is in severe pain. Further, if the nose is broken, until the child is taken to the hospital, you only need to stop the bleeding. As soon as the baby is injured, it is necessary to apply cold to the nose and bridge of the nose. In winter it may be snow or ice. In the summer, you can apply a towel or T-shirt soaked in cold water to stop the flow of blood.

The victim's head is tilted to the side, he is forbidden to blow his nose or touch the sore spot with his hands. To relieve pain, the fracture can be treated with an anesthetic spray or given a tablet.

If a child has a broken nose, you should never:

• Lower your head back so that dried blood does not clog your nasal passages and get into your throat;
• Insert tampons and cotton into the nasal cavity;
• Set broken bones back on your own.

Features of the structure of the organ

The nose is a complex organ that performs a number of important functions. There are 2 parts of the organ: external and internal (nasal cavity).

The outer part is visible to the naked eye on the face of each person, and it has purely individual structural features, as a result of which the shape of the nose is different for each person.

The organ consists of 2 paired bones that are attached to the frontal part of the skull. The wings of the nose and its tip consist of cartilaginous tissue .

The inside of the nose is a cavity bounded by the nasal bones and the hard and soft palate. The nasal cavity is divided into 2 parts by an internal septum, which consists of cartilage tissue.

A known feature is that this partition in each person is slightly shifted to the side, so each of these two parts differs in size.

The anatomical features of the structure of the nose, the presence of a large number of constituent bone parts and cartilaginous tissue, make this organ very vulnerable, therefore, it can easily be broken, even with minor mechanical impact.

There are several main types of nasal bone fractures:

1. Frontal depression . It is considered the most common type of nasal fracture in children. In a child, both nasal bones and the septum are simultaneously broken, resulting in a violation of the integrity of his pyramid. In especially severe cases, the bones of the upper jaw are affected. This type of fracture leads to a significant change in the shape of the nose, when it becomes very wide and takes on a saddle shape.
2. Nose displacement. As a result of the traumatic impact, one of the paired bones breaks and the integrity of the nasal septum is damaged. As a result, a cosmetic defect occurs - a crooked nose.
3. Irregular comminuted fracture . A complicated form of injury that occurs when there is multiple damage to the middle part of the face.
4. Lateral indentation . Occurs during a side impact.

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Causes

Numerous negative factors lead to disruption of the integrity of the nasal bones in children.

The main reasons to be:

• mechanical impact on the nasal area of ​​certain objects during active games and sports (for example, hits with a football or basketball);
• falling (for example, while running);
• fights;
• injuries caused by sudden door opening;
• injuries during an accident;
• hit by a heavy object (for example, a swing);
• playing with objects that are not appropriate for the child’s age.

Symptoms and signs

How to identify a broken nose in a child? A broken nose is a reason to see a doctor as soon as possible. However, how can one recognize this problem and understand that a child has a broken nose?

To do this, it is necessary to evaluate the totality of clinical manifestations that may indicate the presence of a fracture. Such manifestations include:

1. Bleeding from the nose (internal or external), which occurs immediately after injury.
2. Painful sensations in the damaged part of the face. Pain can be felt not only when impacting the nose, but also at rest. Although, even with a slight touch, the pain intensifies many times and becomes unbearable. If a child, due to his age, cannot tell his parents about his feelings, he begins to scream and cry loudly.
3. Swelling and inflammation of the mucous membranes of the nose.
4. Hematomas or bruises in the eye area on both sides.
5. Deformation (curvature) of the nose.
6. Difficulty breathing (if the integrity of the nasal septum is violated, when it blocks the nasal passages). At first after injury, the child breathes only through his mouth, since nasal breathing is impossible.

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Straightening the partition

A few days later, when the doctors were convinced that the bone was as it should be, we were offered, without leaving the hospital, to immediately undergo a second operation - to correct the nasal septum. “The professor during his rounds said that she turned into an accordion,” my son said proudly. But now he was already afraid to go to the operating table, because, whatever one may say, all manipulations associated with the nose are very painful, and the postoperative course of injections is also not a pound of raisins. My son kept calling home on his cell phone, crying, getting on the nerves of both me and the doctors, so they even had to take the phone away from him, but he still managed to allow me to come on the day of the operation.

...They brought him on a sleeping gurney and he continued to sleep until late in the evening, and then into the night. In fact, there was no need for my presence. But while I was sitting here, the doctor showed me a film on the computer of how the operation took place. It was scary to look at the nasal cavity enlarged to the size of a screen, but the journalist’s curiosity got the better of him.

Expert commentary. In case of injury, a deviated nasal septum occurs less frequently than a fracture or retraction of a bone. But the operation to restore it is more difficult. In most of our hospitals it is performed the old fashioned way, using a method developed back in 1901. Directly in front of the place where the curvature is located, the doctor cuts the mucous membrane with a scalpel, peels it off, identifies the deformed area, cuts it out and throws it away. Then he presses the mucous membrane tightly with a gauze swab. The tampon lasts up to five days.

But the fact is that the cartilage of the nasal septum on both sides is covered with perichondrium, from which it grows, and the mucous membrane rests on it. Often, in the place where a fragment of the perichondrium is removed along with a piece of cartilage, under the influence of a constant flow of air, the mucous membrane begins to “dry out”. At first, a small hole is formed in it, which becomes larger and larger over time, the cartilage becomes exposed and gradually collapses. A hole appears in the nasal septum, and when it becomes the size of a penny, a new operation is required to “patch it.”

But now there are other techniques that allow you to “level” the septum in a less traumatic way. For example, surgery using a microscope or endoscope. The doctor inserts a thin fiber-optic tube into the nasal cavity, which has a built-in light guide and a video camera that transmits the image to the monitor screen. Moreover, he reaches the place of curvature of the cartilage without damaging the mucous membrane, but by making an incision in the skin at the entrance to the nostril. The tissues are moved apart, the deformed section of the cartilage is removed, taken out, it is placed in a special “crusher”, where the cartilage is straightened, and it is inserted back. The nasal septum is compressed on both sides with silicone plates and stitched for fixation. A small cosmetic suture is made at the entrance to the patient's nostril. After a week, the silicone plates can be removed. The septum is even, the mucous membrane is not broken or inflamed, the nose breathes well!

How to distinguish from a bruise?

Mechanical trauma to the nose may result in a fracture or bruise. These 2 concepts must be distinguished , since each of these options requires different treatment. How to distinguish a bruised nose from a broken bone?

When a child is bruised, pain occurs, however, if there is a fracture, the pain is much more pronounced.

With a bruise, the pain goes away after a while; with a fracture, the pain persists for a longer period of time.

With a bruise, there is difficulty breathing, however, the child can still breathe through his nose, albeit with difficulty. With a fracture, nasal breathing is impossible.

Features of nasal trauma in children

A peculiarity of childhood nasal trauma is that, due to the small anatomical size of the nose and rapidly developing traumatic edema, the external deformation is hardly noticeable. Therefore, after any, even seemingly minor, bruise of the nose, the child should be shown to an otolaryngologist without delay. In addition, if your child’s nose injury was intentionally caused by the offender and a trial is planned, then it is necessary to undergo a medical examination of the severity of the injuries. Early examination of the nasal cavity with endoscopic optics and x-ray examination allows you to promptly identify externally hidden injuries and promptly begin their treatment. Otherwise, with age, during the growth of the damaged skeleton of the nose, its external deformation may develop, and the progressive curvature of the broken nasal septum can completely turn off nasal breathing.

Do not be upset if, for some reason, the surgical treatment your child needs for a fracture of the nasal skeleton was not carried out in a timely manner. In the children's department of our Center, proprietary methods for correcting deformities of the septum and external nose (rhinoseptoplasty), adapted for children of various ages after previous trauma, have long been developed and successfully used.

Make an appointment at the reception of our Center with Dr. med. Sciences Rybalkin S.V. You can call: 8(499) 968-69-12.

What to do if the temperature rises?

If a fracture of the nasal bones is accompanied by hyperthermia, especially if the child’s body temperature reaches dangerous levels, it is necessary to urgently call an ambulance .

a cool bandage applied to his forehead .

If necessary, give an antipyretic suitable for pediatric use and in accordance with the recommended dosage.

Preparation for surgery to reposition the nasal bones

Repositioning of the nasal bones is a non-emergency operation, therefore in our clinic it is performed after comprehensive preparation.
Children undergo laboratory blood and urine tests and receive consultation from a dentist and cardiologist. The procedure is performed using general anesthesia, so young patients must be consulted by an anesthesiologist. If your child has chronic diseases, you can additionally consult with medical specialists (neurologist, allergist, endocrinologist, etc.). A conclusion on admission to surgery is issued by a pediatrician after studying the examination data. Read more about comprehensive preoperative preparation >>>

Diagnostics

In order to make an accurate diagnosis , the doctor must:

• examine the patient to assess the clinical picture;
• interview the child to establish the nature of the complaints and the situation in which the injury occurred;
• do an x-ray and ultrasound of the organ;
• You may need to consult other specialists, such as an ENT specialist, a surgeon, an ophthalmologist.

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Treatment regimen

Treatment of a fractured nasal bone includes several mandatory steps:

1. Pain relief . To eliminate bleeding, swelling and pain, apply a cooling bandage to the damaged area.
2. For the same purpose, the child is prescribed painkillers.
3. To restore nasal breathing, it is necessary to use nasal drops
4. To prevent infection of damaged tissues, antibacterial therapy .
5. If necessary, when there is a severe fracture, a procedure is prescribed nose repositioning.
   This operation is considered very painful, so it should only be performed by an experienced specialist.

   The child must be calmed down and seated in a chair so that he is comfortable. After this, anesthesia is administered (in most cases general). At the same time, ice is placed on the nose. After a few minutes, the doctor presses on the side walls and root of the nose, returning it to its normal physiological position.

First aid

First aid is to alleviate the child's condition. First of all, you need to calm him down, and then proceed with the following actions:

• in case of nosebleeds, ask the baby to breathe through the mouth;
• if there is no bleeding, tilt your head back;
• in case of bleeding, place a cotton pad soaked in peroxide in the nose;
• For the first 15 minutes, apply ice to the bridge of the nose, having previously wrapped it in a thin cloth;
• in case of severe pain, give the child a painkiller;
• If there is a wound, wash it with an antiseptic and apply a bandage.

Care and recovery

A child after a fracture of the nasal bones needs a recovery period and special care .

The duration of the recovery period may vary, it depends on the severity of the fracture, the presence of other injuries that the child may have received during the injury, the general condition of his body and well-being.

Throughout the entire recovery period, the child must be provided with peace, sports, physical activity, the use of glasses, and visits to the steam room are strictly prohibited .