Nose injury (nasal fracture) - symptoms, diagnosis, treatment

What to do?

Emergency care for superficial injuries (superficial scratches, minor bruises) can be provided at home: the injuries should be washed with soap and water, and ice should be applied to the bruised area. If blood is flowing from the wound, a tampon with hydrogen peroxide should be pressed onto the area for 3–5 minutes.
Bleeding from the nose - in the absence of signs of fracture of the nasal bones and nasal septum - you can try to stop it yourself (by packing the nasal passage with a tight gauze or cotton swab moistened with hydrogen peroxide or cold water). If the bleeding is severe and, despite all efforts, does not stop, you must call an ambulance.
If you suspect a fracture of the nasal bones or nasal septum, you should contact a specialized clinic as soon as possible.

Symptoms

Clinical signs of a nasal fracture:

A nasal fracture causes severe pain. The patient is in shock or even fainting.
Slight bleeding from the nasal slits occurs, which is blocked quickly and independently. In quite rare cases, blood flows in a stream and requires nasal packing. Such bleeding can lead to significant blood loss.
The skin and mucous membranes are damaged, which can be manifested by the accumulation of air in the superficial fat layer. During the examination, the doctor determines whether the wound communicates with the nasal cavity.
Then swelling of the soft tissues of the nose, eyes and cheekbones develops, bruising appears in the area of the cheekbones and eyelids. Hemorrhage under the skin occurs as a result of damage to blood vessels. After a day, swelling of the nose and surrounding tissues becomes extensive. Bruises form around the nose and under the eyes. Noticeable swelling in the impact area allows you to know whether the nose is broken. This symptom, combined with pain, deformity and bleeding, gives the characteristic clinical picture of a nasal fracture.
Difficulty in nasal breathing is caused by displacement of bone fragments, deformation of the nasal septum, and increasing swelling.
In case of a fracture of the bone and cartilaginous structures of the nose, the crunching of the fragments is determined by palpation - a clear sign that allows the traumatologist to make the correct diagnosis and prescribe adequate treatment.
If the nose is broken, mucus continuously leaks from it.
In the future, infection may occur and fever, pain and redness may appear at the site of the lesion. Softening of the tissue indicates the beginning of the process of abscess formation.

Dangerous symptoms

If you suspect a fracture of the nasal bones or nasal septum, it is important to pay attention to the following signs of combined trauma and complications:

heavy bleeding. Possible in case of damage to the nasal mucosa with bone fractures;
lacrimation. May occur with combined trauma to the orbit and lacrimal ducts;
release of cerebrospinal fluid. It is observed with a fracture of the ethmoid bone, which is adjacent to the upper nasal passages.

It is difficult for a layperson to distinguish between lacrimation and a cerebrospinal fluid leak, so clear or blood-stained fluid coming from the nose should raise suspicion. In such cases, you should seek qualified help as soon as possible.

Causes

Various types of injuries can lead to a fracture:

of a domestic nature (a fall, for example, while intoxicated or as a consequence of an epileptic seizure);
criminal in nature (causing bodily harm, causing intentional harm to health);
of a sporting nature (obtained through boxing and martial arts);
production (often the result of safety violations).

Recently, injuries sustained in a car accident have also become more frequent. Military injuries are possible.

Nasal septum fracture

Nose trauma is always accompanied by swelling, which does not allow doctors to perform surgery on the same day, so treatment always begins with conservative therapy. In addition, a nasal injury can be combined with a concussion, in which surgery is undesirable, so a pause of several days is a necessary condition.

The bone of the bridge of the nose may simply sink from the blow, without a fracture. It may break, but not completely, but like a willow branch breaks: the break is only on one side, on the other - everything is intact. These types of fractures are most often observed in children, because their bone tissue contains more elastic fibers than adults. In any case, the bone must be put back in place to restore nasal breathing and the external shape of the nose.

In our country, such operations are performed in two ways.

An old method that is still used in some hospitals. Under local anesthesia with a special instrument, similar to a long narrow spatula, the bone is lifted and fixed from below with a tight gauze swab. After a day or two they take it out, and the bone... sometimes it falls off again.
A new method that uses anesthesia (general anesthesia). Foreign doctors have proven that fixing tampons are actually not needed. The main thing is to place the bone correctly, because there are no muscles around it that could move it. And it is more convenient to place it correctly if the operation is performed under general anesthesia: the patient does not feel anything, does not experience fear, does not interfere with the surgeon’s work... In this case, a small tampon made of perforated rubber is used, with gauze inside, which serves only to absorb moisture. It does not injure the mucous membrane as much as a tight gauze swab does, and healing proceeds faster. Within a month, a bone callus forms at the site of retraction, which firmly strengthens the bridge of the nose. Such operations are performed abroad and in many domestic clinics.

How to identify a broken nose?

How do you know if there is a fracture or not?

Trauma specialists identify the following symptoms of a nasal fracture:

Strong, sharp painful sensations;
Nose bleed;
Swelling localized in the eye area, cheekbones;
Bruising, subcutaneous hemorrhages;
Deformation;
Respiratory dysfunction;
Intense lacrimation.

The listed clinical manifestations indicate that the nose is broken and require immediate assistance to the victim! Symptoms of a broken nose may vary slightly, depending on the type and location of the injury. If we are talking about an open type of injury, then there is a wound surface in which bone fragments are visible.

In this case, there is a high risk of infectious complications, as evidenced by such alarming clinical symptoms as redness of the skin, increased body temperature, fever and softening of tissue structures. A closed nasal fracture without displacement is characterized by preservation of shape. Damage can be determined by taking into account the following signs of a nasal fracture - swelling, hematoma formation, minor subcutaneous hemorrhages, ruptures of the mucous membrane, a feeling of pain and discomfort.

A characteristic sign of open/closed injury is bleeding. If the respiratory organ is broken, the bleeding is very profuse and intense. Damage with displacement of fragments is accompanied by deformation. This injury is indicated by curvature, shift of the septum, or change in the shape of the respiratory organ.

It is important to learn to identify a fracture from bruises and unpleasant symptoms that occur with other types of injury (for example, what signs appear if you simply break an organ, and not break it). This can be done by understanding the features of the clinical picture.

If the nose is injured, but not broken, then the swelling is localized only at the edges of the damaged organ, pain is present, but quite tolerable (if the integrity of the bone is broken, the pain is very strong, the likelihood of falling into a state of shock is high). Bleeding is also mild and is stopped using compresses and vasoconstrictor drops.

After a heel fracture, the joint hurts

In general, the signs of bruises and fractures are quite similar, however, a broken organ has a more pronounced clinical picture, and only with a fracture can bone fragments be displaced!

What is the danger?

After a nasal fracture, a person needs competent, comprehensive therapy followed by rehabilitation. Otherwise, the following consequences of a broken nose are possible:

Deviated septum;
Sinusitis;
Chronic rhinitis;
Attachment of infectious processes;
Impaired olfactory function;
Neuritis;
Recurrent nosebleeds;
Hyposmia;
Anosmia.

Infection is considered one of the most dangerous complications, significantly complicating and delaying the healing of the damaged organ. If the bone tissue of the skull and meninges were injured, then there is a high probability of developing meningitis. The consequences can be the most dire - even death! With severe hemorrhage in the area of the eyeball, visual impairment and even complete blindness are possible.

With timely provision of competent medical care, the victim can be cured, preventing the development of adverse consequences!

What to do if your nose is broken?

First aid for a broken nose is aimed at relieving pain and relieving swelling. For these purposes, it is recommended to make a cold compress or apply a heating pad with ice to the injured area. It is also necessary to take measures aimed at stopping bleeding. The basic rule is to sit or stand straight, tilt your head as far back as possible and close your nostrils. Then swabs treated with hydrogen peroxide should be placed in the nostrils.

In case of open damage, the wound surface should be treated with antiseptics to avoid infection. In case of severe pain, give the victim (if it is an adult) a painkiller tablet to reduce the risks of possible painful shock. After the initial actions have been carried out, the victim must be taken to the trauma department of the clinic, where he will be provided with professional medical care and adequate therapy will be prescribed! Under no circumstances should you try to straighten damaged bones yourself - such actions can cause serious harm to the patient’s health and provoke a number of complications!

How to treat a broken nose?

Treatment of a nasal fracture involves repositioning to restore the correct position of the bone fragments. Correction and straightening are carried out under local anesthesia. Depending on how severe the injury is, the operation can be performed manually or using a special tool - an elevator, which allows you to lift the sunken area of the bone. In more severe clinical cases, surgery—rhinoplasty—can help correct the situation.

It is possible to restore the shape of the respiratory organ surgically only after the swelling has been eliminated, 10–14 days after the injury!

Further restoration of the nose is conservative. Tampons treated with antibiotic drugs are inserted into the patient's nostrils, and sometimes a fixing bandage is applied, which should be worn for 2 weeks.

Deviated nasal septum

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, according to the Killian method, developed back in 1901. In front of the place where the curvature is located, the doctor uses a scalpel to cut the mucous membrane, peel it off and cut out the deformed area. Then he presses the mucous membrane tightly with a gauze swab. The tampon lasts up to 5 days.

The problem is that the cartilage of the nasal septum is covered on both sides by the perichondrium, from which it grows, and the mucous membrane is already located on it. In the place where the 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. A hole may form in it, which enlarges over time, while the cartilage becomes exposed and may begin to deteriorate. In such cases, repeated surgery is required to close the resulting hole.

Now there are techniques that allow you to align the septum in a less traumatic way. For example, surgery using a microscope and endoscopic techniques. 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, they reach the place of curvature of the cartilage without damaging the mucous membrane. An incision is made in the skin at the entrance to the nostril. The tissues are moved apart, the deformed section of cartilage is removed, taken out, straightened using a special apparatus, and inserted back. The nasal septum is compressed on both sides with silicone plates and stitched for fixation. A small cosmetic stitch is made at the entrance to the nostril. After a week, the silicone plates can be removed. The septum turns out smooth, the mucous membrane does not suffer or become inflamed, the nose breathes freely.

Diagnostics

To establish a diagnosis, you must follow the following points:

Carefully collect anamnesis of the disease . Find out the reasons for the development of the pathological condition, establish the mechanism of injury development.
Collect a life history , specifying the presence of concomitant injuries to the ENT organs, blood diseases and hormonal imbalance in the anamnesis.
Inspect the damage site . In order to carry out a proper inspection, there must be sufficient lighting in the room and the inspection must also be carried out in the surrounding areas.
Conduct palpation examination . Palpation should not bring severe painful sensations. If they are observed, then their location and approximate intensity should be determined in the shortest possible time. Next, it is recommended to choose a treatment tactic.
Anterior and posterior rhinoscopy . If rhinoscopy is painful, then local anesthesia with lidocaine solution should be performed.
X-ray diagnostics. This method is the “golden” diagnostic criterion, which helps determine the presence and course of the fracutra line, and also predetermines the course of further treatment.
CT scan. This method should be used only in cases of low X-ray information content.
Ultrasound ECHO-graphy is used to determine the extent of traumatic damage and choose further treatment tactics.
Examination using endoscopic technique . This method is quite accurate, because it allows you to see the lines that limit microhematomas. Based on the distribution of these lines, it is possible to outline a line that corresponds to the fracture. But besides this, it becomes possible to detect changes in the mucous membrane and clarify where the source of bleeding is.

Where to treat nasal injuries?

It is best to treat a nasal injury in a clinic that specializes in oral and maxillofacial surgery. The diagnosis of a fracture of the nasal bones and nasal septum is usually made on the basis of x-rays.

Such injuries are dangerous not only because of a cosmetic defect. A change in the diameter of the nasal passages due to injury often leads to the subsequent development of persistent vasomotor rhinitis. When one of the nasal passages narrows, the child’s brain, through the neuro-reflex endings located in the mucous membrane, receives a signal about trouble (as with inflammation). In this regard, a reflex secretion of mucous fluid begins, similar to a runny nose. Such a “runny nose” can bother a person throughout his life. Sometimes in such cases, the patient is mistakenly diagnosed with “allergic rhinitis” and appropriate therapy is carried out for a long time, persistently and unsuccessfully. Meanwhile, if correction is carried out in time after an injury, nothing like this will happen.

If surgery is necessary, parents have 7-10 days after the injury (while the swelling subsides) to choose a hospital.

Clinic selection criteria:

Find out which hospitals perform nasal septum surgeries under general anesthesia. The requirement is understandable: in such ENT departments there are specially trained anesthesiologists, doctors are proficient in modern techniques, the operation can be performed efficiently and comfortably for the child, and recovery will come faster.
Ask how often such operations are performed in this hospital, including for children.
If you are going to have surgery on the nasal septum, it is good if it is done under a microscope or using endoscopy.

Indications and contraindications

A traumatic nasal fracture requires immediate intervention. Rhinoseptoplasty is a major operation that is performed under general anesthesia, so there are contraindications for it:

general serious condition;
Diagnosed with blood clotting problems;
inflammatory processes in the facial area;
allergic reactions to anesthesia;
chronic diseases in the acute stage;
acute viral diseases;
herpes.

Sources

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Prices

Price (rub.)In installments* (rub.) Consultation with a surgeon for surgery (SPECIAL)0—Online doctor’s opinion on surgery (SPECIAL)0—Reposition of nasal bones from 7700—Reposition of nasal bones under ETIfrom 15000—

* You can read more about the conditions here - Treatment on credit or in installments

The cost is preliminary. The exact cost of the operation can only be determined by a surgeon during a free consultation.

How long does it take for a broken nose to heal?

A nasal fracture, like any other, requires competent and comprehensive treatment. However, the anatomical features of the nasal bones in case of minor injuries greatly facilitate healing. For example, due to the fact that the nasal bones are motionless and have no joints, the risk of being injured again is reduced, and good blood supply in this area provides nutrition to the tissues and stimulates their fusion. Often, with timely assistance, it takes about three months to heal a simple closed fracture, and up to six months to recover from an open fracture (in especially severe cases, long-term treatment may be required for up to a year).

Causes and symptoms of a broken nose

It is important during the treatment process to pay attention to rehabilitation procedures, which should be carried out in parallel with the main therapy. So, there are a number of recommended activities that will help speed up recovery:

UHF therapy. It has an anti-inflammatory effect and promotes tissue restoration.
Treatment with infrared radiation lamps. This procedure is good for getting rid of infection, which is especially important when it comes to an open fracture.
Electrophoresis. Electrical impulses accelerate metabolic processes in tissues, which, in turn, catalyzes the regeneration process.

Each of these procedures has its own advantages and disadvantages, and only a qualified doctor can choose the appropriate type of physiotherapy based on the requirements in each specific case.

Possible complications and consequences after a fracture

Sometimes, when treatment was started untimely or was of poor quality, complications can occur at any severity of the injury. The most common ones include:

deformation of the nasal septum and, as a result, difficulty breathing through the nose;
cosmetic defect expressed in the curvature of the bridge of the nose;
suppuration (included in the group of possible complications with an open type of fracture).

Such complications include sepsis (blood poisoning) and damage to the membranes of the brain. They can occur exclusively with an open fracture when the disinfection of the wound was not carried out thoroughly enough and the wound became infected. In case of blood infection (accompanied by high body temperature, redness and tension of the skin around the wound), a blood transfusion and antibiotic therapy are urgently needed. If infection of the meninges is diagnosed, the patient requires urgent resuscitation in a hospital setting and a long course of treatment.