Nose injuries and fractures

Proven content

Nose injuries and fractures are situations that should not be underestimated. The outer nose is responsible for protecting the eyeballs and the brain from damage that can be suffered in various circumstances, e.g. in fights, traffic accidents, accidents at work, during sports activities, falls with hitting hard objects or the floor.

A few words about injuries and fractures of the nose

Nose injuries and fractures are, after head and neck injuries, the most common injuries caused by traffic or household accidents. How extensive and dangerous the injuries are depends primarily on the structure and strength of the bones. Especially the facial skeleton, due to the limited mobility of its structures, is to a large extent exposed to all kinds of fractures.

The nose is made of elements of different elasticity, it is quite flexible and without any serious consequences it takes the effects of injuries with limited energy. Due to its external position, the nose is exposed to various injuries. Larger injuries result in a rupture or fracture of the nose, mainly in the nasal bones and parts of adjacent bones, resulting in a deformation of the nose, dislocation to the side, or the formation of a depression (“saddle”) in the upper part. It is usually accompanied by bleeding (hemorrhage) from the nose. Soon, swelling of the soft parts of the nose and increasing difficulties in nasal breathing are observed. Sometimes the nasal sinuses are damaged by trauma to the nose. Therefore, it is important to visit the otolaryngology department immediately in order to have the injuries treated and appropriate treatment initiated.

Symptoms of injuries and fractures of the nose

Nasal injuries typically include the cartilage of the nasal septum, the soft tissues of the nose, and the bone tissue that builds up the nose. In extreme cases, injuries to the nose involve the eyeballs, eye sockets, ear or mouth. In turn, the symptoms of fractures and injuries of the nose are:

1. severe nose pain and tenderness,
2. discontinuity of soft tissues,
3. displacement of bone structures,
4. swelling of the nose causing difficulty breathing and an impaired sense of smell
5. watery eyes
6. trouble breathing
7. nose dislocations or fractures
8. dislocations or fractures of the nose scaffold,
9. local hematomas, e.g. around the nose and under the eyes (this symptom should not be underestimated),
10. bleeding and nosebleeds.

The most common complication of nasal injury is epistaxis. This is because the mucosa that lines the nasal cavity is very supplied with blood. In young people, the source of bleeding is generally in the front of the nasal septum, at the site of the Kiesselbach (vessel network). On the other hand, in the elderly, the bleeding focus is located in the rear part of the nasal cavity, where the branches of the pharyngeal artery run. Haemorrhages occurring in nasal injuries are usually very severe, which makes it difficult to stop them. Nose bleeds are often associated with other complications, such as haematomas or abscesses.

Hematomas and abscesses in injuries and fractures of the nose

1. Hematomas are a consequence of a nose injury. The blood that comes out of the vessels collects between the nasal mucosa and the nasal septum. It can also accumulate between the cartilaginous tissue and the cartilage, which is then a reservoir filled with blood. Large-size hematomas cause the patient to have difficulty breathing through the nose. It is then necessary to puncture the hematoma under local anesthesia and remove the blood accumulated inside it.

2. Nasal septum abscess is also a consequence of a nasal injury. Too late removal of the hematoma causes the residual blood in it to become a breeding ground for bacteria and the development of an infection. It is then that purulent inflammation occurs, which includes the peritoneum and the cartilage of the septum. For this reason, patients experience severe pain in the nose and frontal area, accompanied by increased temperature. Always treat abscesses to avoid serious consequences, including meningitis, nasal septum defects. Antibiotic therapy is implemented as treatment.

Broken nose

The fracture of the nose can be with or without displacement. This depends on the factor that caused the injury. In addition, a broken nose may cause intussusception of its bone structures. Therefore, treatment depends on the nature of the changes that arise. Superficial fractures are usually treated with manual adjustment and application of a tamponade, which aims to immobilize the adjusted structures. However, more serious and more severe fractures are treated surgically under general anesthesia. Then, a significant reposition is made as soon as possible to avoid bone adhesions.

Often, during injuries, dislocation of the nasal vestibule. From the outside, it is invisible, although the internal structures have been disturbed. Dislocation is accompanied by pain and bleeding. In the treatment of simple dislocations, a stiffening tamponade is used, while larger lesions are subjected to ENT procedures.

Note: Breaking the nose can injure the brain. So if, after about 7-10 days, you notice: dizziness and headaches, nausea and vomiting, memory problems, loss of consciousness and clear fluid leakage from the nose – see a doctor as soon as possible.

Nose injuries and fractures – first aid

Help with injuries and fractures of the nose at home consists in placing the patient in a sitting or reclining position with the head tilted downwards. The idea is to prevent blood from flowing down the throat. You can also give the patient painkillers in the form of oral tablets. Quick transport of the patient to an ENT office (outpatient clinic, emergency room) is necessary because specialist assistance immediately after the injury may protect the patient from late consequences of the injury, complications or the need for surgical treatment.

After a medical visit, however, one should remember, for at least a few weeks after an injury or a broken nose, the possibility of late sequelae and complications after a nose injury, such as:

1. bleeding from one nasal passage starting about a week or more,
2. clear, watery fluid coming out of one nasal passage
3. worsening problems with nasal breathing due to gradual reduction of both or one-sided nasal patency,
4. Subcutaneous pneumothorax, i.e. the accumulation of air under the eyelids and narrowing the eyelid gap, accompanied by a characteristic crackling sensation when lightly touched with the fingers,
5. pain and redness of the skin in the nose, increased temperature.

All these symptoms or similar, appearing individually or in a complex, require the advice of an ENT specialist.

Nose injuries and fractures – diagnosis and treatment

In order to diagnose injuries of the nose, it is necessary to take an X-ray, thanks to which the fracture and possible displacement of the bones and crunchiness of the nose can be visualized. In some cases, there are indications for X-ray of the spine and computed tomography of the head.

Treatment depends on the type of fracture. Displacement fracture of the nose requires adjustment during surgery. It is a good idea to perform it when the swelling has slightly subsided, as it may blur the image of the fracture and be an obstacle to the correct positioning of the nose. The procedure should not be performed more than two weeks after the injury because bone adhesions have formed that make surgery impossible. Then the only solution is nose plastic surgery or setoplasty. Compare the offers of clinics that offer this treatment.

In non-displaced fractures of the nose, it is usually enough to adjust it manually and then insert a stiffening tamponade.

Rhinoplasty may be performed closed method. It involves anesthetizing the nose from the inside, and then setting the bones in place using special tools. Open nose positioning is performed when fragments of broken bones are wedged or the septum of the nose is curved / broken. After adjusting the nose, the broken fragments should be stabilized using the front tamponade, which is removed approximately five days after the surgery.

Comfrey root can be used for fractures. Its infusion has a soothing effect and you can make compresses from it.

Quite often, doctors prescribe an antibiotic to minimize the risk of infection, as well as painkillers and anti-swelling preparations. It is very important that patients after surgery avoid contact with people who suffer from a respiratory tract infection.

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