About 40% of all facial injuries are broken noses. The nose is the prominent part of the face, which is why it is the most vulnerable organ. Usually, a fracture occurs due to direct trauma from a fight, an accident, sports, or an accidental fall (usually in childhood). All these factors lead to injury to the bone that forms the back of the nose, or to the cartilage that forms the anterior and lateral wings. Most often, injuries are diagnosed in men between the ages of fifteen and forty. And it has to do with the way they live. A nose fracture according to ICD-10 is numbered S02.20 and S02.21, which includes injuries of the nose of varying degrees.
Characteristics of the disease
Fracture of the bones of the nose is an injury that leads to a violation of the integrity of the bone pyramid with displacement or without bone fragments. Such injuries often provoke swelling, pain, abnormal mobility of the organ, the occurrence of through holes, bruising in the eye sockets. Often, the injury is accompanied by a fracture of the upper jaw, the nasal septum, cartilage tissues are destroyed, the eye sockets are injured,nasolacrimal ducts.
Most often there is a lateral displacement of the organ, in which the seam 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 nasal pyramid, but the displacement of bone fragments always occurs. If the nasal septum breaks, bruises penetrate the mucous membrane and even tear it.
The features of the deformation of the described organ depend on the strength of the blow and its direction, as well as on the object that caused the blow. Equally important is the individual structure of the nose. With mild damage, a fracture of the lower edge of the bones usually occurs, so no visible deformation is observed. These injuries are usually diagnosed by accidental x-rays.
There are three degrees of severity of a broken nose:
- Easy. In this case, there is a fracture of the bone without displacement.
- The average degree is caused by the displacement of debris without damage to tissues and mucous membranes.
- Severe is characterized by displacement of debris and tissue rupture.
Types of fractures
A broken nose can be one of the following:
- Closed, in which the integrity of the tissues around the broken bone is preserved.
- Open fracture of the nose, in which a wound with bone fragments occurs. This injury is dangerous, as a large loss of blood can occur as a result of damage. Moreover, there is a riskaccession of a secondary infection.
In traumatology, it is customary to distinguish between the following types of nasal 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-s alt 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 injury, 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 fracture of the nose without displacement. With it, there is swelling and bruising at the site of injury. On palpation, the site of the fracture can be found. And in childhood, there is a retraction of the nasal bone.
The design of the fracture depends on the force of 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 - it forms a hump.
- Rhinolordosis - the nose takes on a saddle shape.
- Plithyrinin - characterized by the formation of a wide and somewhat short organ.
- Brachyrinia - caused by deformation of the nose, in which it becomes very wide.
- Leptoria - characterized by a deformity in which it becomes very narrow and thin.
Causes of pathology
Fracture of the bones of the nose occurs for many reasons:
- as a result of domestic injuries, which include punching or hitting with an object;
- due to injuries sustained while playing sports such as boxing, hockey or football;
- from being hit by an animal's hoof;
- as a result of a traffic injury from a fall on the rails or an accident;
- due to falling from a height on his head;
- from being hit by a heavy object;
- due to a military wound.
Symptoms of the disease
Signs of a fracture of the nose are manifested in the form of pain in the area of injury, which is aggravated by palpation. Often the injury is accompanied by a crunch of bone fragments. When the nose is damaged, bleeding always 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 time.
Most often, the back of the nose is shifted to the right, and its slope sinks to the left. Retraction of the bones or cartilage of the back of the nose occurs, giving it a saddle shape.
With a fracture of the nose, which is accompanied by a rupture of the meninges, there is liquorrhea, which can be detected by tilting the head forward. In some cases, it is not possible to diagnose the leakage of cerebrospinal fluid, which can lead to complications. A day later, swelling spreads to the eyelids and cheekbones, nasal breathing becomes impossible.
Often, a fracture is accompanied by hemorrhage into the eye chamber, displacement of the eyeball andsqueezing muscles, which can cause blindness.
Signs of a broken nose are usually expressed like this:
- severe pain in the nose;
- puffiness of tissues;
- appearance of hematomas and bruises in the area of the nose and eyes;
- nose deformity;
- Nosebleeds that are hard to stop;
- mucus secretion;
- shortness of breath.
First Aid
Before the arrival of the doctor, it is necessary to provide first aid to the victim. To do this, you must first stop the bleeding with the help of cold, which is applied to the nose. It can be just a handkerchief soaked in cold water. The person's head is tilted back and turned to the side.
In case of a fracture with a displacement, it is urgent to deliver the victim to the doctor, nothing can be done on his own.
Very often, a broken nose is confused with an ordinary bruise, so they do not go to a medical facility. Pronounced bruises around the eyes, located symmetrically, may indicate a fracture of the bones of the skull, which means that it is necessary to immediately undergo an examination.
When a pain shock occurs, it is necessary to prevent the development of its consequences. To do 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 facility in a semi-sitting position, making sure that his head is tilted back.
You can't palpate your bleeding nose and move it in differentdirections, as this can provoke the development of complications in the form of displacement of bone fragments.
Diagnostic examination
Diagnosis begins with the collection of anamnesis 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 of how the injury was caused, what subject, whether there was a loss of consciousness, nausea, as well as the presence of organ damage in the past.
Next, the doctor palpates the bones of the nose, while the patient has pain, crunching debris, and mobility of the organ. After that, the patient is given a rhinoscopy to determine the site of the rupture of the epithelium 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 in nasal secretions of glucose indicates the leakage of cerebrospinal fluid as a result of a rupture of the lining of the brain. In this case, the patient is referred to neurosurgery.
Fracture of the nose involves x-rays and CT scans. X-ray is done in several projections, which makes it possible to identify the fracture line, the displacement of debris and the site of damage to the septum. With the help of CT, damage to the bones of the skull, eye sockets, paranasal sinuses and other things can be seen. Also, the doctor may prescribe ultrasound, endoscopy and puncture of the spinal cord.
Nose fractures require consultationneurosurgeon to rule out brain damage. This is especially true for severe injuries, accompanied by loss of consciousness. In case of trauma to the eye sockets, an ophthalmologist's consultation is prescribed, and in case of a fracture as a result of an epileptic seizure, a neurologist.
Treatment measures
The main goal of therapy in this case is the reconstruction of the nose and the restoration of nasal breathing. Treatment of a nose fracture can be either conservative or require surgery. Which methods will be applied depends on the degree of damage, the condition of the patient and his age.
With visible deformation of the nose, repositioning is necessary, after this technique the shape of the nose is restored, breathing resumes. It is usually carried out on the third day after the injury, when the swelling is slightly reduced. In adults, the procedure is performed using local, and in children - general anesthesia. With a concussion, reposition is carried out six days after the injury. After the procedure, the nose is stabilized with cotton swabs, which are placed in the nasal passages, where they should stay for about seven days. The doctor then applies a cast to be worn for about one month.
When cartilage is fractured, 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 required.
Surgical treatment
When soft tissues are damaged, a surgical intervention is performed, during which the doctor seeks to preserve tissues as much as possible, removing only dead ones. Surgery is performed with a scalpel or laser.
In case of detachment of a soft tissue area or its complete separation, replantation 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 of the cases, there is a post-traumatic deformity of the nose, so patients are forced to undergo repeated treatment in the future. In this case, it is necessary to perform rhinoplasty under general anesthesia. 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 the hospital for another 10 days. If after removal of the dressing and removal of tampons there is no bleeding, and the result of the operation is good, the patient is discharged.
After a broken nose, a person should exclude physical activity, visiting pools and saunas for a month. It is also not recommended to wear glasses during this period.
Often the doctor prescribes vasoconstrictor drugs for a 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 in a way that does not injure the damaged nose, it is best to do this on the back.
Complications and consequences of a broken nose
The damage to he alth as a result of the injury described can be significant. So, not only cosmetic changes in the organ, but also a violation of its functions can act as complications. Hematoma often leads to the development of cartilage necrosis, which subsequently deforms. If the ethmoid bone is fractured, meningitis or a brain abscess may develop.
Deviated 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 the water-s alt balance, suppuration of tissues.
With the development of suppuration and abscess of cartilage tissue, the latter eventually acquires an ugly shape, which negatively affects the appearance of the victim.
None of the methods of treatment today does not give one hundred percent results of a complete recovery, and often patients re-apply to a medical institution to eliminate unpleasant consequences. The results of the pathology can manifest themselves as a slight deformation, and in the form of the impossibility of nasal breathing.
Forecast and prevention
Prognosis of pathology can be favorable in case of simple injuries, in case of timely therapy and compliance with all medical prescriptions. For severe fractures, the prognosis will depend on how damaged the brain is. After an injury, a person is considered disabled untilone month. Sometimes a second surgery is required after some time. Complications of fractures indicate the need for timely diagnosis and ideal anatomical reduction.
In order to prevent the above, it is necessary to avoid injuries, follow the safety rules when playing sports. When the first symptoms of a fracture appear, you should immediately contact the clinic. Only an experienced doctor should deal with pathology.
Today, the treatment of fractures requires an ideal anatomical comparison of the bones and their retention until complete fusion. Unfortunately, often damage leads to the development of complications. And an improperly fused fracture becomes the reason for repeated visits to the doctor. Therefore, with any damage to the organ, you need to contact the clinic to prevent the development of complications in the future. Self-medication in this case is strictly prohibited.
