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Nose fractures account for 40% of the total number of facial injuries, since this organ protrudes above its surface and, as a result, is the most vulnerable. In most cases, such a fracture occurs as a result of direct trauma.
The main causes of this type of injury are fights (34%), traffic accidents and accidents (28%), sports activities (23%), as well as accidental falls, which mainly affect children.
As a result, the bone that forms the back of the nose, or the cartilaginous tissue from which its front part and side wings are formed, is injured.
Fracture classification
Like any other fracture, a nasal fracture can be closed or open, with or without displacement. With a closed fracture, the integrity of the tissues and skin around the broken bone is not violated; with an open fracture, an open wound is formed through which bone fragments can be seen. An open fracture is dangerous with a large loss of blood and the risk of infection.
With a closed fracture without displacement the shape of the nose does not change, swelling appears on the face, a bruise forms at the site of the injury. The point of localization of the fracture can be detected by palpation. An x-ray will be required to confirm. Visual depression of the nose can be noted, in young children – the sinking of the nasal bone. With severe trauma, ruptures of the nasal mucosa are possible.
Open fracture without displacement characterized by the same signs, which are complemented by a violation of the integrity of the skin and mucous membrane at the fracture point and the presence of protruding bone fragments.
Displaced nose fracture – this is a more complex and severe injury that can cause respiratory disorders and have such long-term consequences as water and electrolyte imbalance disorders, purulent lesions of soft tissues, trigeminal neuritis, etc., not to mention a cosmetic defect and the need for rhinoplasty.
Most often, the shift occurs to the side. It is possible to shift the entire nose, in which the shape of its back does not change. Such deformation is visually hardly noticeable. Cartilage tissue is quite elastic, so it lends itself well to reduction in case of displacement.
In most cases, the classification of nasal fractures according to Yu. N. Volkov is used, which takes into account the nature of the injury, the strength and direction of the blow.
According to this classification, nasal fractures are:
Without displacement of bones and deformation of the outer part of the nose;
With displacement and deformation;
With damage (curvature) of the nasal septum;
With damage to the processes of the maxillary bone;
With a divergence of the nasal bone at the seams.
Signs and symptoms of a broken nose
The main symptoms of a broken nose include:
Sharply expressed pain in the nasal region, which is aggravated by touch and palpation;
Increasing swelling of tissues in the nose;
Bruising (bruising) around the nose and under the eyes
A change in the shape of the nose, which can be observed even with closed fractures and without displacement, and is a consequence of edema;
Nosebleeds, which may be intense or scanty, but in any case it is difficult to stop;
Discharge from the nose of a mucous nature;
Difficulty in nasal breathing.
A day after the injury, edema captures the cheekbones and eyelids, there is no nasal breathing. With a fragmental fracture, such a phenomenon as crepitus (a characteristic crunch when touched) and pathological mobility can be observed.
Pronounced symmetrical bruises around the eyes, especially if they did not appear immediately, but gradually, may indicate not only a nose injury, but also a fracture of the skull base bones, therefore, in this case, it is recommended to immediately conduct an appropriate examination (MRI or CT scan of the skull base and cervical region spine).
First aid for a broken nose
First of all, you need to try to stop the bleeding from the nose. To do this, in winter, you can attach snow or ice to the bridge of your nose. In summer, you can put a handkerchief or a piece of clothing on your nose, turning your head to the side and throwing it back a little.
In the case of a displaced fracture, the victim should be taken to a medical facility as soon as possible and nothing should be done on their own.
A fracture without displacement is often mistaken for a simple bruise, in which case an x-ray must be taken to clarify the diagnosis.
Nose fracture treatment
The doctor finds out the circumstances under which the injury was received, palpates the nose, then rhinoscopy, endoscopy and radiography are prescribed. X-ray allows you to determine the degree of damage, the line of fracture, the presence or absence of displacement and bone fragments. An x-ray can detect a fracture in the early stages, when there is still no significant swelling and inflammation of the soft tissues.
A fracture without displacement is treated with conservative methods: the injury site is cooled and painkillers (ketanov, dexalgin) are used. Sometimes vasoconstrictor drugs are prescribed in the form of nasal drops, but they should not be abused. To relieve swelling and eliminate bruises, you can use ointments (troxyvasine, rescue).
In case of a fracture with displacement and the presence of fragments, a surgical operation is performed – reposition of the bones of the nose. It is recommended to carry out it within 7-10 days after the injury, not later, in this case it will be possible to do without general anesthesia. During the operation, application and injection anesthesia (2% lidocaine) is done, then, using a special elevator, the sunken bone is lifted and the nose is fixed with tampons containing antibiotics. Tampons are installed for a period of at least 3 days.
If more than 10 days have passed since the injury, then rhinoplasty or septoplasty (correction of the nasal septum) will be required. In the case of a deviated septum, the negative consequences of a nasal fracture can be an abscess, chronic rhinitis or sinusitis.