About 40% of all facial injuries occur in a broken nose. The nose is an outstanding part of the face, which is why it is the most vulnerable organ. Typically, a fracture occurs due to direct trauma as a result of a fight, an accident, playing sports, as well as an accidental fall (usually in childhood). All these factors lead to bone injury, which forms the back of the nose, or cartilage, which forms the front and side wings. Most often, lesions are diagnosed in men between the ages of fifteen and forty. And this is due to the way they live. Fracture of the nose according to ICD-10 is numbered S02.20 and S02.21, which includes injuries of the nose of varying degrees.
Disease characteristics
A fracture of the nasal bones is an injury that leads to a violation of the integrity of the bone pyramid with displacement or without bone fragments. Such damage often provokes swelling, pain, abnormal organ mobility, the occurrence of through holes, bruising in the orbit. Often the injury is accompanied by a fracture of the upper jaw, the nasal septum, cartilage tissue are destroyed, the orbits, nasolacrimal ducts are injured.
Most often, a lateral displacement of the organ occurs, in which the suture between the bones and processes of the upper jaw is disconnected, hematomas appear that can provoke an abscess. In some cases, there is no displacement of the nose pyramid, but displacement of bone fragments always occurs. If the nasal septum breaks, bruising penetrates the mucous membrane and even its rupture is possible.
The deformation features of the described organ depend on the strength of the impact and its direction, as well as on the object that caused the impact. Equally important is the individual structure of the nose. With light damage, a fracture of the lower edge of the bones usually occurs, therefore, no visible deformation is observed. Typically, such injuries are diagnosed with an accidental exposure.
There are three degrees of severity of a nose fracture:
- Easy. In this case, a bone fracture without displacement is observed.
- The average degree is determined by the displacement of fragments without damaging the tissues and mucous membrane.
- Severe is characterized by displacement of fragments and rupture of tissues.
Varieties of fractures
Nose fracture may be one of the following varieties:
- Closed, in which the integrity of the tissues around the broken bone is maintained.
- An open fracture of the nose, in which a wound with bone fragments occurs. This injury is dangerous, as a result of damage can result in a large loss of blood. In addition, there is a risk of secondary infection.
In traumatology, it is customary to distinguish between these types of nose injuries:
- Fracture with displacement. It acts as a complex form of damage that can provoke respiratory distress and have complications in the future in the form of a violation of the water-salt balance, purulent infection of soft tissues, and neuritis. With such an injury, the shape of the nose changes (usually the displacement occurs to the right side).
- Open fracture of the nose without displacement. It is caused by a violation of the integrity of the skin and epithelium at the site of damage, as well as the presence of bone fragments in the wound. Such an injury is more complex and requires immediate hospitalization. Self-medication in this case is prohibited.
- Closed nose fracture without displacement. With it, there is swelling and bruising at the site of injury. On palpation, you can find the fracture site. And in childhood, there is a retraction of the nasal bone.
The design of the fracture depends on the strength of the impact and the side of the nose to which it was applied. Deformations in this case can be as follows:
- Rhinoscoliosis - characterized by lateral displacement of the organ.
- Rhinokyphosis - with it a hump forms.
- Rhinolordosis - the nose takes a saddle shape.
- Plitirinin - characterized by the formation of a wide and somewhat short organ.
- Brachyrinia - caused by deformation of the nose, in which it becomes very wide.
- Leptorinia - characterized by a deformation in which it becomes very narrow and thin.
Causes of pathology
A fracture of the nasal bones occurs for many reasons:
- as a result of domestic injuries, which include blows with a fist or an object;
- due to injuries sustained while playing sports, such as boxing, hockey or football;
- from an animal’s hoof;
- as a result of a transport injury when falling onto the rails or accident;
- due to falling from a height on his head;
- from hitting a heavy object;
- due to military injuries.
Symptoms of the disease
Signs of a nasal fracture are manifested in the form of a pain syndrome in the area of injury, which increases with palpation. Often the injury is accompanied by a crunch of bone debris. Always when the nose is damaged, bleeding occurs, which then stops on its own. This is due to damage to the mucous membrane. But in severe cases, nosebleeds may not stop for a long period of time.
Most often, the back of the nose shifts to the right, and its slope sinks to the left. Bones or cartilage of the back of the nose are sagging, giving it a saddle shape.
With a fracture of the nose, which is accompanied by a rupture of the meninges, liquorrhea is observed, which can be detected by tilting the head forward. In some cases, it is not possible to diagnose leakage of cerebrospinal fluid, which can lead to complications. After a day, swelling extends to the eyelids and cheekbones, nasal breathing becomes impossible.
Often, a fracture is accompanied by hemorrhage into the eye chamber, displacement of the eyeball and muscle squeezing, which can cause blindness.
Signs of a broken nose are usually expressed as follows:
- severe pain in the nose;
- swelling of the tissues;
- the appearance of bruises and bruises in the nose and eyes;
- deformation of the nose;
- nosebleeds, difficult to stop;
- mucus secretion;
- difficulty breathing.
First aid
Before the arrival of the doctor, first aid must be provided to the victim. To do this, you must first stop the bleeding with the help of a cold, which is applied to the nose. It may just be a handkerchief soaked in cold water. The man’s head is tipped back and turned to the side.
In case of a fracture with a displacement, it is urgent to deliver the victim to the doctor, you cannot do anything on your own.
Very often, a nose fracture is confused with an ordinary bruise, so they do not go to a medical institution. The pronounced bruises around the eyes, located symmetrically, can indicate a fracture of the skull bones, which means that it is necessary to immediately undergo an examination.
If pain shock occurs, it is necessary to prevent the development of its consequences. For this, the victim must be brought to his senses with a cotton swab dipped in ammonia. It is necessary to transport him to a medical institution in a half-sitting position, making sure that his head is thrown back.
You can not independently feel the bleeding nose and move it in different directions, since this can provoke the development of complications in the form of displacement of bone fragments.
Diagnostic examination
Diagnosis begins with a history and examination of the patient. The doctor listens to complaints, examines the deformation of the organ, determines the degree of pain, the presence of debris, the duration of bleeding. During the survey, the question also arises of how the injury was caused, what subject, whether there was a loss of consciousness, nausea, or the presence of organ damage in the past.
Next, the doctor palpates the bones of the nose, while the patient has soreness, a crunch of fragments, organ mobility. After that, the patient is given rhinoscopy to determine the place of epithelial rupture and the source of bleeding, as well as the curvature of the septum. In addition, he is prescribed laboratory tests of blood, urine, ECG to determine the degree of blood loss, changes in the activity of other organs.
Detection of glucose in the nasal secretions indicates leakage of cerebrospinal fluid as a result of rupture of the brain membrane. In this case, the patient is referred to neurosurgery.
Nose fracture involves radiography and CT. Radiography is done in several projections, which makes it possible to identify the fracture line, the displacement of the debris and the location of the damage to the septum. With the help of CT, damage to the bones of the skull, orbits, paranasal sinuses and other things is visible. Also, the doctor may prescribe an ultrasound scan, endoscopy and puncture of the spinal cord.
For nasal fractures, a neurosurgeon consultation is required to rule out brain damage. This is especially true for severe injuries accompanied by loss of consciousness. When injuring the orbits, an ophthalmologist’s consultation is prescribed, and in case of a fracture as a result of an epileptic seizure, a neurologist.
Therapeutic measures
The main goal of therapy in this case is the reconstruction of the nose and the restoration of nasal breathing. Treatment of a nasal fracture can be either conservative or require surgical intervention. What methods will be applied depends on the degree of damage, the condition of the patient and his age.
With visible deformation of the nose, reposition is necessary, after this technique the shape of the nose is restored, breathing resumes. Usually it is carried out on the third day after the injury, when the edema decreases slightly. In adults, the procedure is performed using local, and in children, general anesthesia. With a concussion, reposition is performed six days after the injury. After the procedure, the nose is stabilized with cotton swabs, which are installed in the nasal passages, they should be here for about seven days. Then the doctor applies a cast, which must be worn for about one month.
When a cartilage fracture, reposition is not performed. The hematoma is immediately drained to prevent the development of infectious inflammation and cartilage necrosis. During treatment, the doctor prescribes painkillers and sedatives, antibiotics. A tetanus vaccine is also needed.
Surgery
If soft tissue is damaged, surgery is performed during which the doctor seeks to preserve the tissue as much as possible, removing only the dead. Surgery is performed using a scalpel or laser.
In case of separation of the soft tissue site or its complete separation, a re-implantation is performed. The graft is sewn to the damaged area, after which antibiotics and a tetanus vaccine are prescribed. In this case, the operation should be carried out no later than seven hours after the injury.
In half the cases, post-traumatic deformity of the nose is observed, so patients are forced to undergo re-treatment in the future. In this case, rhinoplasty under anesthesia is necessary. During the operation, nasal breathing is restored, and then the cosmetic defect is eliminated with the help of implants.
After surgical treatment, the patient is in hospital for another 10 days. If bleeding does not start after removing the dressing and removing the tampons, and the result of the operation is good, the patient is discharged.
After a nose fracture, a person should exclude physical activity, visiting swimming pools and saunas for a month. It is also not recommended to wear glasses during this period.
Often, the doctor prescribes vasoconstrictor drugs throughout the week to restore nasal breathing. To prevent changes in the epithelium of the nose, it is necessary to take Sinupret for one month. It is recommended that the patient sleep, so as not to injure a damaged nose, it is best to do this on his back.
Complications and consequences of a nose fracture
The health damage resulting from the described injury can be significant. So, not only cosmetic changes in the organ, but also a violation of its functions, can act as complications. A hematoma often leads to the development of necrosis of cartilage, which subsequently deforms. With a fracture of the ethmoid bone, meningitis or brain abscess may develop.
Curvature of the septum causes chronic rhinitis and sinusitis. With fractures, a curvature of the nose often occurs, which is permanent and manifests itself in the form of a hump or asymmetry. Late complications include the development of respiratory failure, a disorder of water-salt balance, suppuration of tissues.
With the development of suppuration and abscess of cartilage, the latter eventually acquires an ugly shape, which negatively affects the appearance of the victim.
None of the methods of treatment today gives one hundred percent results of a full recovery, and often patients re-apply to a medical institution to eliminate unpleasant consequences. The results of the pathology can be manifested both as a small deformation, and in the form of the impossibility of nasal breathing.
Forecast and Prevention
The prognosis of the pathology can be favorable for simple injuries, in case of timely therapy and compliance with all prescriptions of the physician. In severe fractures, the prognosis will depend on how damaged the brain is. After an injury, a person is considered incapable of work for up to one month. Sometimes repeated surgical intervention is required after some time. Complications of fractures indicate the need for timely diagnosis and ideal anatomical reposition.
In order to prevent the above, it is necessary to avoid injuries, observe safety rules when playing sports. If the first symptoms of the fracture appear, you should immediately contact the clinic. Only an experienced doctor should deal with the treatment of pathology.
Today, the treatment of fractures requires an ideal anatomical juxtaposition of bones and their retention until complete healing. Unfortunately, damage often leads to complications. And an incorrectly healed fracture becomes the reason for a second visit to a doctor. Therefore, for any organ damage, you need to contact the clinic to prevent the development of complications in the future. Self-medication in this case is strictly prohibited.