When the nose is broken, there is a violation of the integrity of the bones with or without displacement of the fragments. Fractures can lead to swelling, tenderness, bruising, abnormal mobility, and so on. The diagnosis can usually be made simply by the clinical picture. Treatment of a displaced or non-displaced nose fracture includes reduction (if necessary), stabilization with tampons, conservative therapy (painkillers, nasal vasoconstrictors, antibiotics, etc.).
Symptoms
Treatment of a broken nose also depends on the accompanying symptoms. With minor bleeding and no displacement, the patient can be sent home, prescribing only an anesthetic, and with significant edema, vasoconstrictor drugs will be needed. So, the signs of a fracture are: pain, which increases with probing, nosebleeds, whichstops on its own (with severe damage, bleeding can be prolonged, stop, and then open again), soft tissue edema, hematomas, respiratory failure, decreased sense of smell, cerebrospinal fluid release when bending forward (it is impossible to determine this on your own). Often with such an injury, there is a deterioration in vision, hemorrhage in the eye and displacement of the eyeball.
Causes of injury
Fracture can occur as a result of various injuries. Signs of a broken nose and treatment (basic principles) are well known to professional athletes. Such a sports injury is typical for boxers and those involved in various types of martial arts. Often, a fracture is diagnosed after an accident. This may be a work injury (mostly this happens when safety rules are not followed). But most often, a fracture of the bones of the nose occurs as a result of household trauma. This is a fall due to a seizure or in a state of intoxication, a showdown or a fight.
Fracture Shapes
Treatment of a broken nose is prescribed after the diagnosis and determination of the form of the 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, the nasal displacement to the side (rhinoscoliosis), retraction of the back (rhinolordosis), 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 thisplatyrinia, only wide - brachyrinia, too narrow - leptorinia. Depending on the prescription of the injury, acute fractures (up to six weeks) and consolidated (if the injury was received more than six weeks ago) are distinguished.
Diagnosis
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, concomitant diseases and the presence of nasal injuries in the past are clarified. During the physical examination, tenderness, the presence of bone fragments, nasal mobility, the degree of edema and the type of deformity are revealed. The degree of blood loss can be determined by the results of general studies, including urine, blood ECG and other methods. The results of these laboratory studies can make changes in the tactics of treating the patient. For example, when glucose is detected in secretions, we are talking about a rupture of the meninges. It is impossible to detect this on your own, only laboratory methods are used. In this case, the treatment of a broken nose is carried out in the neurosurgical department.
Highly informative for nasal injuries X-ray 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, echography allows you to clarify the extent of damage. With the help of endoscopy, you can examine the posterior sections and nasal septum. Mucosal tears and exposure of bone or cartilage may be found.
Injuriesof the facial region of the skull are often accompanied by hemorrhage around the orbit, but this symptom can also appear with other injuries. To clarify the diagnosis, a 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 rigid stretcher. Even X-rays cannot be taken immediately, because for this you need to turn your head.
Any injury involves a 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, the treatment of fractures of the bones of the nose is carried out after consulting a surgeon and an ophthalmologist. In case of an injury resulting from a fall during an epileptic seizure, it is necessary to visit a neurologist. If there are 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 put snow or ice on the bridge of your nose, and in summer, a handkerchief or a piece of clothing. First you need to turn your head and tilt back a little. In winter, reducing or completely stopping bleeding is much easier. The cold will prevent swelling. With a fracture, bleeding is usually more profuse and prolonged than with other injuries of the nose, so it is possible that only doctors can completely stop the bleeding.
Set the broken onesbones can't be done on their own. In case of a fracture with displacement, the victim should be taken to the hospital as soon as possible. You cannot do anything on your own. Treatment of a closed fracture of the nose without displacement should also be carried out only by a doctor. In this case, the injury is often mistaken for a bruise, but an x-ray must be taken to clarify the diagnosis. Any activity that is carried out by non-medical personnel is potentially dangerous. You can aggravate the situation and increase bleeding.
Fracture treatment
When a patient presents with symptoms of a broken nose, treatment is not started immediately unless there is severe bleeding and open lesions that require immediate attention. First, the doctor will find out the circumstances under which the damage was received, carefully 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 main rule in the treatment of a broken nose is early reduction. With severe bleeding, you have to resort to tamponade. Tamponade is carried out, if possible, after determining the nature of the fracture, in order not only to stop the bleeding, but also to set the displaced parts. With gross intervention, mucosal ruptures 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 only be reduced to providingfirst aid, after which it is necessary to deliver the victim to the hospital and follow the recommendations of the doctor.
In the first five to six hours, ice must be applied to the injured area to reduce swelling and stop bleeding. In addition to the introduction of tampons, sedatives and painkillers, vasoconstrictor drugs are indicated. In some cases, the use of antibiotics is justified. The basis for stopping tamponade is to stop nosebleeds, restore the shape of the nose and nasal breathing. It is mandatory to administer tetanus toxoid to the victim and prescribe a course of physiotherapy.
Treatment of a fractured nose without displacement involves conservative methods. The injury site is cooled, painkillers are used, for example, Dexalgin or Ketanov. In some cases, vasoconstrictor nasal drops are prescribed, but such drugs cannot be abused. To relieve swelling and eliminate bruising, you can use therapeutic ointments. Troxevasin ointment and Rescuer work well.
In most cases, the patient is sent home after repositioning and prescribing medication. Treatment of a broken nose at home involves the implementation of all the recommendations given by the doctor. Indications for treatment in a hospital are fractures accompanied by severe traumatic bleeding, severe external deformity, damage to the orbit, brain and paranasal sinuses.
In case of a fracture with a displacement, the treatment is surgical, namely reposition (reduction)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 a strong edema will already disappear. If you do the procedure later, you will need general anesthesia, and not local anesthesia. If a concussion is diagnosed, the reduction of the bones is postponed to a later date.
During the operation, an injection of lidocaine (2%) is given for pain relief, and then, using a special instrument, the broken bone is lifted and fixed with antibiotic-soaked swabs. The tampon is installed for at least three days to maintain shape and stop bleeding. For severe fractures, there may be indications for intervention under general anesthesia with further application of a plaster cast.
Within a month after the injury, the treatment of a fracture of the nose without displacement or with displacement provides for a sparing regimen. It is necessary to exclude physical activity, refuse to visit the sauna or bath, and 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 the surgeons insert instruments under the skin or mucous membrane. During an open operation, the osteocartilaginous skeleton of the nose is exposed through incisions along the inner edge.
Patients who have been prescribed surgical treatment must stay in the hospital for another ten days. If after removal of tampons from the nose or removal of the bandage during the day there is no severe bleeding, and the result of the surgical intervention is satisfactory, the patient can be discharged. In the vast majority of cases, the fracture has a positive prognosis. In severe trauma, it all depends on the degree of damage to the brain. The treatment time for a nose fracture is 14 to 28 days. The exact length of the recovery period depends on the nature of the injury. The duration of treatment for a nose fracture without displacement (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, the same number of 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 shells dried. After a few days (the shell should dry out), the shell will dissolve in the 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 must be shaken. The course of treatment can be completed after eating three servings. In addition, it is recommended to regularly consume raw egg shells. Half a teaspoon of powder in the morning and evening is enough.
Treatment of a fracture in a child
If the patient is a child, the treatment is not much different from similar measures if an adult was injured. As a first aid, you need to apply ice to the fracture site to eliminate swelling and stop bleeding. You can not tilt the child's head. If there are symptoms of a concussion, it is best not to transport the casu alty to the hospital on your own. This should be done by specialists so as not to aggravate the situation. Parents need to call the doctors immediately. Until the arrival of doctors, you can not leave the child unattended. It is not recommended to blow your nose. This can cause debris to move and bleed heavily.
After the diagnosis, the child is given treatment. Therapy depends on the severity of the injury. To keep the bones in a normal position, gauze swabs are inserted into the nasal passages. For the duration of 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, the installation of metal plates is required. Dressings should be done daily. The treatment lasts about one to two weeks.
It is important to remember that fractures heal faster in children than in adults, so you need to see a doctor as soon as possible. If you delay, the bones may not heal properly. Because of this, doctors will need to break the child's nose again and set everything correctly. The treatment of a displaced nose fracture is more difficult, so to avoidtraumatic procedure, you should go to the hospital immediately after the injury.
Common mistakes
Treatment of a broken nose at home is unacceptable. Even with minor bleeding, you should visit a medical facility to diagnose the injury and get advice from a doctor. You can not feel the bleeding nose, try to move it or try to straighten it. If the danger is to dislodge parts of the bone. Then a non-displaced fracture will become a displaced fracture. Treatment of a closed fracture of the nose is mandatory only under the supervision of a doctor. It is imperative to seek medical help with any nose injury. This will allow you to start treatment on time and exclude a dangerous complication - a hematoma, in which an abscess, suppuration and further deformation of the cartilage occur. Because of this, the nose will subsequently take on an ugly shape.
Oddly enough, but taking the victim to the emergency room is not the best 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. A person with a broken nose should be transported in a half-sitting position with his head tilted back. If edema has not yet developed, then the victim (if necessary) will be offered to undergo an operation immediately. For a month after this, you need to protect the nose from re-injury or infection.
Complications
After a nose fracture, the nasal septum may deviate, leading to a deterioration in normal nasalbreathing. The consequence of this are constant sinusitis and rhinitis. An aesthetic defect may remain - a curvature of the nose. With a fracture with a displacement, complete blockage of nasal breathing is possible, as a result of which respiratory failure often develops. Dangerous 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.
