When a nose fracture occurs, a violation of the integrity of the bones with displacement or without displacement of fragments. Fractures can lead to edema, soreness, hematomas, pathological mobility and so on. The diagnosis can usually be made simply by the clinical picture. Treatment of a nasal fracture with or without displacement includes reduction (if necessary), stabilization with tampons, the use of conservative therapy (painkillers, vasoconstrictor drugs for instillation into the nose, antibacterial medications, etc.).
Symptoms
The treatment of a nasal fracture also depends on concomitant symptoms. With minor bleeding and the absence of displacement, the patient can be sent home, having prescribed only pain medication, and with significant edema, vasoconstrictor drugs will be needed. So, the signs of a fracture are: pain, which intensifies when palpating, nosebleeds, which stops on its own (with severe damage, bleeding can be prolonged, stop, and then open again), soft tissue swelling, hematomas, respiratory failure, decreased sense of smell, discharge cerebrospinal fluid when leaning forward (to determine this alone is impossible). Often with such an injury, visual impairment, eye hemorrhage and displacement of the eyeball are observed.
Causes of injury
A fracture can occur as a result of various injuries. Signs of a nasal fracture and treatment (basic principles) are well known to professional athletes. This sports injury is characteristic of boxers and those involved in various types of martial arts. Often, a fracture is diagnosed after an accident. This may be a work injury (this mainly happens if the safety rules are not followed). But most often, a fracture of the nasal bones occurs due to household injury. This is a fall due to a seizure or intoxication, disassembly or fight.
Fracture forms
Treatment for a nasal fracture is prescribed after diagnosis and determination of the form of injury. Depending on the action of the factor that provoked the injury, and its features, open and closed fractures are distinguished. In the latter case, the integrity of the skin is not violated. According to the nature of the deformation, lateral displacement of the nose (rhinoscoliosis), backward retraction (rhinolordosis), and deformation with the formation of a hump (rhinokyphosis) are distinguished. If the nose has become too wide and short as a result of an injury, then it is platirinia, only wide - brachirinia, too narrow - leptorinia. Acute fractures (up to six weeks) and consolidated (if the injury was received more than six weeks ago) are distinguished depending on the age of injury.
Diagnostics
The doctor will ask about the circumstances of the injury, the severity, duration of bleeding, the presence of additional symptoms (vomiting and nausea, loss of consciousness). In addition, the accompanying disease and the presence of nasal injuries in the past are being clarified. A physical examination reveals soreness, bone fragments, nasal mobility, the degree of edema, and the type of deformity. The degree of blood loss can be determined by the results of general studies, including analysis of urine, blood ECG and other methods. The results of these laboratory tests can make a difference in the treatment of the patient. For example, when glucose is detected in secretions, it is a rupture of the meninges. It is impossible to independently detect this, only laboratory methods are used. In this case, the treatment of a fracture of the nose is carried out in the neurosurgical department.
Highly informative for injuries of the nose, x-rays and CT. The images show fracture lines, displacement of fragments, fracture site, damage to the orbits, paranasal sinuses, skull bones and so on. In some cases, ultrasound can determine the extent of damage. With the help of endoscopy, you can examine the posterior sections and septa of the nose. Mucosal tears and exposure of bones or cartilage can be detected.
Injuries to the facial section of the skull are often accompanied by hemorrhage around the orbit, but this symptom can also occur with other injuries. To clarify the diagnosis, spinal puncture is performed. A fracture of the base of the skull can be suspected if the patient is unconscious, stunned. Such a patient must be transported on a hard stretcher. Even X-rays can not be done right away, because for this you need to turn your head.
Any injury involves consultation with a neurosurgeon to rule out brain damage. This is necessary in case of a serious condition of the victim with loss of consciousness or in the presence of other neurological symptoms. In case of damage to the orbit and cheekbones, treatment of fractures of the nasal bones is carried out after consultation with the surgeon and optometrist. For injuries sustained during a fall during an epileptic seizure, you must visit a neurologist. In the presence of concomitant symptoms from the lungs, heart and blood vessels, other organs, a consultation with a therapist, cardiologist and other specialists is indicated.
First aid
First aid to the victim is to stop the bleeding. In winter, you can attach snow or ice to the bridge of the nose, and in summer, a handkerchief or part of the clothes. First you need to turn your head and tilt back a little. In winter, it is much easier to reduce or completely stop bleeding. Cold will prevent the formation of edema. With a fracture, bleeding is usually more plentiful and prolonged than with other nose injuries, so it is possible that only doctors can completely stop the blood.
It is impossible to repair broken bones yourself. In case of a fracture with displacement, the victim must be taken to the hospital as soon as possible. You can’t do anything on your own. Only a doctor should treat a closed nose fracture without displacement. In this case, the injury is often mistaken for a bruise, but an x-ray must be taken to clarify the diagnosis. Any actions that are not carried out by medical personnel are potentially dangerous. You can aggravate the situation and increase bleeding.
Fracture treatment
When a patient with symptoms of a nose fracture arrives, treatment does not begin immediately if there is no severe bleeding and open injuries that require immediate help. First, the doctor will find out the circumstances in which the damage was received, gently palpate and prescribe a rhinoscopy, x-ray or endoscopy. Radiography will determine the nature of the damage, the line of fracture, the absence or presence of displacement, bone fragments. But this method allows you to detect a fracture in the initial stages, when there is still no severe inflammation of the soft tissues.
The basic rule for treating a nasal fracture is early reduction. With severe bleeding, you have to resort to tamponade. Tamponade is carried out whenever possible after determining the nature of the fracture, so as not only to stop bleeding, but also to correct the displaced parts. With gross intervention, mucosal tears and displacement of fragments can be increased. Therefore, only a doctor can stop bleeding in this way. Self-treatment of a nose fracture in a child or adult can be reduced only to first aid, after which it is necessary to deliver the victim to the hospital and follow the doctor's recommendations.
In the first five to six hours, ice must be applied in the area of injury to reduce swelling and stop bleeding. In addition to the introduction of tampons, sedatives and painkillers, vasoconstrictors are indicated. In some cases, the use of antibiotics is warranted. The basis for the termination of tamponade is stopping nosebleeds, restoration of the nose and nasal breathing. Mandatory introduction of tetanus tetanus to the victim and the appointment of a course of physiotherapy.
Non-biased nasal fracture treatment involves conservative methods. The damage site is cooled, painkillers, for example, Dexalgin or Ketanov, are used. In some cases, vasoconstrictor drops in the nose are prescribed, but such drugs should not be abused. To relieve swelling and eliminate bruising, you can use therapeutic ointments. Troxevasin ointment and “Rescuer” work well.
In most cases, the patient after setting and prescribing drugs is sent home. Treatment of a nasal fracture at home provides for the implementation of all the recommendations that the doctor gave. Indications for treatment in the hospital are fractures, accompanied by severe traumatic bleeding, severe external deformation, damage to the eye socket, brain and paranasal sinuses.
In a fracture with a displacement, surgical treatment is performed, namely, reposition (reduction) of bones. It is recommended to carry out the manipulation seven to ten days after the injury, but not later. This is the optimal time, since severe swelling will already disappear. If you do the procedure later, then you will need general anesthesia, and not local anesthesia. If concussion is diagnosed, bone reduction is postponed to a later date.
During the operation, an injection of lidocaine (2%) is made to anesthetize, and then, using a special tool, the broken bone is lifted and fixed with tampons saturated with antibiotics. The tampon is installed for at least three days to maintain shape and stop bleeding. In severe fractures, there may be indications for an intervention under general anesthesia with further application of a plaster cast.
Within a month after the injury, treatment of a nasal fracture without displacement or with displacement involves a gentle regimen. It is necessary to exclude physical activity, refuse to visit a sauna or bath, wearing glasses is also undesirable.
If more than ten days have passed since the injury, septoplasty, that is, correction of the nasal septum, or rhinoplasty, will be required. This is a plastic surgery, during which the anatomy of the nose and its functions are restored. The operation is performed in a closed or open way under anesthesia. In the first case, the cartilage and bones of the nose are not exposed, and surgeons inject instruments under the skin or mucous membrane. In open surgery, through the cuts along the inner edge, the bone-cartilage skeleton of the nose is exposed.
Patients who have been prescribed surgical treatment should be in the hospital for another ten days. If, after removing tampons from the nose or removing the bandage, severe bleeding is not observed during the day, and the result of the surgery is satisfactory, the patient can be prescribed. In the vast majority of cases, a fracture has a positive prognosis. In severe trauma, it all depends on the degree of brain damage. The terms of treatment for a nose fracture are from 14 to 28 days. The exact duration of the recovery period depends on the nature of the injury. The term of treatment for a nasal fracture without bias (treatment in this case is symptomatic), for example, may be shorter, but will be at least ten days.
Folk methods
Fractures heal faster if folk remedies are used. For example, there is such a recipe. It will take five lemons, as many eggs, fifty grams of cognac and two tablespoons of liquid honey. Cognac in this recipe is replaced by cahors. Raw chicken eggs must be mixed with honey, and the shell dried. After a few days (the shell should dry), the shell will dissolve in lemon juice. Then you need to mix the compositions and insist for another day. It is recommended to use thirty grams of the mixture. Before use, the medicine should be shaken. The course of treatment can be completed after consuming three servings. In addition, it is recommended to regularly eat raw eggshells. Enough half a teaspoon of powder in the morning and evening.
Child fracture treatment
If the patient is a child, treatment is not much different from similar measures if an adult was injured. As first aid, you need to apply cold to the fracture site to eliminate swelling and stop bleeding. You can not throw back the child’s head. If there are symptoms of concussion, it is best not to transport the victim to the hospital on their own. This should be done by specialists so as not to aggravate the situation. Parents need to call a doctor immediately. You cannot leave a child unattended until doctors arrive. It is not recommended to blow your nose. This can cause debris to move and heavy bleeding.
After the diagnosis, the child is prescribed treatment. Therapy depends on the complexity of the injury. To maintain the bones in a normal position, gauze swabs are inserted into the nasal passages. During treatment, vasoconstrictor drops and painkillers are prescribed, but usually swelling and pain disappear after five days. In severe injuries, surgical treatment is indicated. It is necessary to fix the nasal septum in the correct position. In some cases, installation of metal plates is required. Dressings need to be carried out daily. Treatment lasts about one to two weeks.
It is important to remember that in children fractures heal together faster than in adults, so you need to see a doctor as soon as possible. If you hesitate, the bones may not grow together properly. Because of this, doctors will need to once again break the child’s nose and set everything right. Treatment of a nasal fracture with a displacement is more complicated, therefore, to avoid a traumatic procedure, it is worth going to the hospital immediately after receiving an injury.
Common mistakes
Treatment of a broken nose at home is unacceptable. Even with minor bleeding, you should visit a medical institution to diagnose an injury and get doctor's recommendations. You can not feel the bleeding nose, try to move it or try to straighten it. If danger displace parts of the bone. Then a fracture without displacement will become a fracture with displacement. Treatment of a closed nose fracture is mandatory only under the supervision of a doctor. Seek medical help without fail, with any nose injury. This will allow you to start treatment on time and eliminate a dangerous complication - a hematoma, in which an abscess, suppuration and further deformation of the cartilage occur. Because of this, the nose subsequently acquires an ugly shape.
Oddly enough, to deliver the victim to the emergency room is not a good idea. It is better to go to the emergency room of the emergency hospital, where there is an ENT department. There, the victim will be provided with more qualified assistance. It is necessary to transport a person with a broken nose in a half-sitting position, throwing his head back. If edema has not yet developed, then the victim (if necessary) will be offered to immediately carry out the operation. Within a month after this, you need to protect your nose from repeated injuries or infections.
Complications
After a nose fracture, a curvature of the nasal septum is possible, which leads to a deterioration in normal nasal breathing. The consequence of this is persistent sinusitis and rhinitis. An aesthetic defect may remain - a curvature of the nose. In a fracture with a displacement, a complete blockage of nasal breathing is possible, as a result of which respiratory failure often develops. Organic accumulation of blood (hematoma) and the formation of suppuration (abscess) of the septum and soft tissues, as well as inflammation of the trigeminal nerve are dangerous.