Among the numerous facial injuries, a nose fracture is considered the most common. Such an injury provokes a violation of the olfactory and respiratory systems. Most often, this condition occurs in everyday life: when falling on slippery ice, the floor, during a fight. But there are also people who are at risk because of their professional activities - athletes and motorists. To restore the state of the organ and set the bones, a reposition procedure is used.
The structure of the nasal cavity
To determine exactly what a fracture is and how to set a broken nose, it is important to know its structure. This organ in the upper region borders on the skull, in the lower region with the mouth, and on the side with the eye sockets. And the structure of his cartilage and bones is the following scheme:
- The outer wall, also called the lateral wall, includes the nasal and palatine bones, the nasal surfacemaxilla, ethmoid bone, frontal process, pterygoid processes of the sphenoid bone and lacrimal bone.
- The side walls are connected by a special partition.
- The posterior upper part consists of the vomer and perpendicular plate of the ethmoid bone.
- The quadrangular cartilage and the movable part of the septum are in the anterior lower part.
- The upper wall includes a lattice plate, which is easily deformed at the time of injury.
- On the side of the nose are the large and small alar cartilages.
In most cases, doctors are faced with trauma to the outer bones of the nose. Very rarely, damage occurs to the walls of the orbits, vomer, turbinates and frontal processes. It is possible to set a broken nose only as soon as possible after the injury.
Main symptoms of a broken nose
All cartilages of the nose are quite easily injured, as they are fragile. The first symptoms of a fracture will directly depend on the type of damage, as well as on the circumstances under which and what exactly it was received.
The common sign of a fracture is bone damage and a pronounced displacement of the back of the nose. If the injury is not severe, then external signs of bone damage are not visible. In this case, the presence of a fracture can be detected only through an x-ray examination or computed tomography. And if it fell only on cartilage, then the integrity of the bones can remain in a normal state.
If characteristic crackling sounds are heard during palpation of the nose, this indicates the exact presence of damage. But in this condition, the patient is forbidden to independently press hard on the nose, feel it and carry out any mechanical actions with it, in order to determine the friction of one bone against another. Such a procedure can only be carried out by the attending physician, otherwise the patient will only worsen his condition and provoke complications.
The main signs of injury include the appearance of swelling in the area of the nose and eyes, the formation of hematomas at the site of impact, bleeding. When pressing on the damaged area, the patient feels a pronounced pain syndrome, nasal breathing becomes difficult for him, and a desire to blow his nose appears. Bloody streaks may appear in the eyeballs. In some cases, the patient has a fever.
What types of fractures are distinguished?
Doctors divide all fractures into the following forms:
- closed - visible violations are minimally expressed (swelling and minor abrasions can be seen);
- open form is manifested by wounds on the skin, in which you can see fragments of bones;
- fracture with subsequent displacement of the bone - in this condition, the shape of the nose changes, becomes asymmetric (it can take place against the background of external damage to the skin or have a closed shape);
- deformation of the nasal septum - the nose will sink inward.
It is important to know all the signs and symptoms of a fracture in order to go to the doctor on time to diagnose and start an effectivetreatment. In particular, a timely appeal to a specialist is required if a child is injured, since in the future his nose may not form correctly, provoking the curvature of the organ, problems with respiratory activity and ENT diseases.
In addition to the first symptoms that appear on the first day after receiving a fracture, the patient, as already mentioned, may have an increase in body temperature. On the third day after injury, infection of the wound with harmful bacteria can occur.
Diagnostics
Before setting the nose, doctors use the following diagnostic techniques:
- Through rhinoscopy, soft tissue ruptures are revealed.
- To understand if there is a displacement of the bones and cartilage, the patient is given an x-ray of the side of the nose.
- Examining internal injuries with an endoscope.
- After that, the patient is scheduled for urine and blood tests.
After carrying out diagnostic measures, the doctor draws up a treatment regimen. It usually looks like this:
- First aid is provided in the form of applying a cold compress to the injured area, which helps to get rid of swelling and relieve pain.
- In case of severe pain, the patient is given sedatives and painkillers.
- Performing a tetanus shot.
- If during the fracture there was a shift of the bones or fragments appeared in them, then reposition is assigned.
Peculiarities of repositioning
To setnose, you can use reposition. The procedure should be carried out in a limited time - from the moment of injury to the reduction of the septum, no more than 21 days should pass. The optimal time for surgery varies from 5 hours to one week. It is during this period that it is important to seek help from a doctor.
How is the nose set after a fracture? If the patient came to the doctor immediately after the injury, but he has a strong swelling of the nose and nearby tissues, then the resection is postponed for several days until the condition of the soft tissues improves. But after the tenth day of the fracture, it is much more difficult to carry out reduction, since a callus begins to form in the diseased area. In this case, the treating specialist will have to carry out the procedure using a special bandage.
Is it possible to set the nose after 3 weeks after receiving a fracture? No, repositioning is not possible. In this case, surgery is delayed for six months, during which the bone is completely fused.
To get rid of the wrong fusion, it will be necessary to perform a complex operation under general anesthesia. The specialist re-breaks the bone at the site of improper fusion and puts it in the correct natural position.
To adjust the nasal septum, the specialist will use a specific method in each case. It will depend on this how quickly and comfortably the treatment itself will pass.
When is reposition used?
Reposition is prescribed for the following types of fracturenose:
- When the back of the nose sinks - rhinolordosis.
- If the nose bone is set too far inward and looks too short or too wide on the outside. Such a fracture is called platyrinia.
- If the nose is shifted to the side - rhinoscoliosis.
- When a hump forms on the nose after a fracture - rhinokyphosis.
Providing treatment
If the patient was assigned a reposition of the bones of the nose, then all therapeutic measures will be divided into several stages:
- Preparation for surgery, in which the patient will undergo procedures to relieve pain shock and eliminate swelling in the affected area, as well as in the sinuses and passages. To get rid of bleeding, tamponade is carried out.
- Setting the nose only hurts if you don't inject anesthesia. Therefore, the area is anesthetized. It is carried out by introducing anesthesia with a syringe or by lubricating the fracture site with a special drug with an analgesic effect.
- Reposition is carried out manually or using elevators. If there are no elevators, then tweezers are used instead, the ends of which are wrapped with a cloth, and a rubber pipe is put on top. The elevator is inserted into the nasal cavity, and from the outside, the doctor works with his hands, gently setting the bone and cartilage to its original position.
- If the structure of the bones has crumbled when a fracture is obtained, then after surgery, tamponade is additionally performed. Swabs soaked in paraffin are inserted into the nasal cavity in order to properlysplicing of bones. Recovery time is most often 14 days.
When is anesthesia needed?
Anesthesia during reposition is used only in the case when the fracture occurred on the nasal septum. This procedure is considered more complex and time-consuming, during which the doctor may need to install implants in the nose. When a hematoma appears on the nasal septum, it is immediately eliminated. Otherwise, the patient may experience some complications, such as cartilage necrosis.
Feedback on the procedure
Many patients leave positive feedback about this procedure during a fracture. Speaking about whether it hurts to set the nose, patients note the painlessness of such therapy, since the doctor introduces special anesthesia before it is carried out. In more complex cases, in order to avoid pain, doctors have to resort to anesthesia.
Hospitalization of the patient is carried out only with severe deformity of the bones of the nose, with prolonged and recurrent bleeding, as well as with a complicated fracture associated with damage to the sinuses, brain and orbits.
