What Is a Nasal Fracture?

The nose is the most prominent part of the face and is easily injured by external forces. Fracture of the nasal bone is a common trauma in the department of ENT, which accounts for about 50% of ENT injuries. Nasal bone fractures can affect the shape of the face and the ventilation function of the nasal cavity. Nasal bone fractures can occur alone. In severe cases, nasal septum fractures, cartilage dislocations, maxillary frontal processes, nasal sinuses, orbital wall, skull base, and other traumas can lead to abnormal structure and function of the corresponding parts.

Basic Information

English name

fractureofnasalbone

Visiting department

Otorhinolaryngology

Multiple groups

Sportsman

Common causes

Direct violence

Common symptoms

External nose deformity, swelling, nosebleeds, nasal congestion, nasal clear water, decreased vision, diplopia, headache, loss of consciousness

Causes of Nasal Bone Fractures

The nose is the highest point on the face and is easily injured by external forces. The bone is thin and wide, and lacks the support of the surrounding bone. It is relatively fragile and prone to fracture. Nasal bone fractures are often caused by direct violence, such as intentional or unintentional trauma, brawls, traffic or work-related injuries during sports. Nasal bone fractures can also be caused by nasal or forehead landing in children when they fall. ^[1]

Clinical manifestations of nasal fractures

1. good group

Inadvertently injured during exercise, injured during conflict, injured in a car accident, or falling on the face.

2. Symptoms

Depending on the degree of trauma, some or all of the following may occur.

(1) Broken nasal bone caused by deformity of external nose .

(2) Swelling of the external nose and surrounding tissues.

(3) Nosebleeds may occur when the nosebleeds hurt the nasal mucosa and blood vessels, and the amount varies.

(4) Swelling of nasal congestion , nasal septum deflection, and nasal septum hematoma can cause it.

(5) Cerebrospinal fluid leakage is indicated by nasal clear water .

(6) Vision loss, diplopia orbital wall and optic nerve damage.

(7) Headache and loss of consciousness may cause intracranial injury.

Nasal bone fracture examination

Inspection

Observe the external nose for deformities, swelling, congestion and orbital edema, whether the eyeballs are displaced, and whether the activities are normal. Depending on the degree of trauma, some or all of the following may appear: skin cracks in the external nose; skew and collapse of the bridge of the nose; collapse or swelling of the back of the nose and root of the nose; swelling and bruising of the external nose and surrounding tissue; nasal congestion or activity Hemorrhage; swollen nasal septum; deviated nasal septum; damaged mucosa in the nasal cavity.

2. Nasal palpation

There is tenderness when touched at the fracture, and bone friction can appear. If the patient has repeatedly blown his nose, subcutaneous emphysema may occur when the air escapes into the outer nose and the surrounding subcutaneous skin, and he may feel a twist when he palpates.

3. Anterior Rhinoscopy

Note whether the nasal mucosa is damaged or bleeding, if there is deflection in the nasal septum, it shows that the septum cartilage is dislocated.

4. Nasal bone imaging

Can show the fracture site, nature, and whether the bone fragments are displaced and the direction of displacement. High-resolution CT and three-dimensional reconstruction can further show the damage of the nasal bone and its adjacent parts.

(1) Lateral nasal bone radiography Generally, the role of lateral nasal radiography is to determine whether there is a nasal bone fracture. It can directly observe bilateral nasal fractures with displaced transverse fractures, sunken fractures, comminuted fractures, and obvious displacement of fracture ends; bilateral nasal fractures are not clearly separated, the bone fragments are small, and hidden fractures Easy to miss diagnosis.

(2) CT scan of the nasal bone for the fracture of the lateral edge of the nasal bone, especially for the surrounding tissue damage such as the presence of effusion in the sinuses, the fracture of the orbital wall, the presence or absence of hematomas in the soft tissue, the fracture of the skull base, and the presence of the orbital Hematocrit and assessment of long-term bleeding may be of great diagnostic value.

5. Nasal endoscopy

Can visually judge the presence of deviated nasal septum, hematoma and abscess, determine the bleeding site and the presence of cerebrospinal fluid leakage.

Diagnosis of Nasal Bone Fracture

Nasal bone fractures are generally diagnosed. Nasal bone fractures usually have a clear history of nasal trauma. When you understand the history, pay attention to the nature, direction, time of injury, and post-injury symptoms. When palpation, the fingers of both hands are gently sliding from the root of the nose to the tip of the nose, and obvious tenderness can be found at the fracture, sometimes accompanied by a skewed or collapsed nasal bridge and a twist. Nasal examination of the nasal mucosa edema, tearing, displacement of the top wall of the nasal cavity to the centerline collapse, dislocation of the nasal septum and deformation, septum hematoma formation, etc. X-ray nasal bone radiograph or CT scan can show the location of the fracture and the direction of bone displacement, which is helpful for diagnosis.

Nasal bone fracture treatment

First aid measures

After a nasal injury, you should go to the hospital in time. At the same time, apply cold packs to the back of the nose, but try to avoid pressing hard. If there is nasal bleeding, pinch both sides of the nose and lower your head to prevent blood from flowing to the throat.

2. No displacement bone and nose fracture

For simple fractures without displacement, those who are not affected by the shape of the nasal cavity and nasal ventilation do not need special treatment, and they will heal naturally.

3. Displaced nasal fracture

Nasal bone fractures with nasal bone displacement should be reset after local soft tissue swelling subsides.

Common reset methods are:

(1) The timing of closed reduction is best to be performed within 10 to 14 days after the injury, and it may be difficult to reduce the reduction due to the formation of callus after 2 weeks.

(2) The open reduction method is unsuccessful when the closed reduction is unsuccessful, or the old nasal bone fracture requires open reduction.

(3) Nasal endoscopic reduction of the nasal bone is suitable for those who have failed closed reduction, 14 to 30 days after trauma, and who have deviated nasal septum.

The treatment of nasal bone fractures must first reset the fractured nasal bones to the original position, and then perform nasal packing to fix the nasal bones. Tightening should be appropriate when packing. Pay attention to protect the nose after surgery. Do not wear glasses. Nasal packing can be fixed after nasal bone fracture reduction. Nasal packing usually takes 2 to 3 days to remove, and the longest one takes 1 week or more. For comminuted and composite nasal bone fractures, it takes longer, but the longest is generally No more than 2 weeks. If the nasal cavity is stuffed for a long time, most patients will experience nasal pain, and severely, they will have reflex headache. The patient's long mouth breathing will cause dryness and pain in the throat, which will seriously affect the patient's sleep and rest.

For the treatment of complex nasal fractures, we must first save the lives of patients, maintain airway patency, and actively treat anti-shock and hemostasis. After the condition is stable, nasal and facial deformities should be corrected to restore the physiological functions of the nasal cavity.

For patients with cerebrospinal fluid leakage, nasal stuffing should not be performed to prevent intracranial infection of nasal bacteria retrogradely. Old nasal bone fractures, due to nasal bone fractures, the epiphysis has been formed, the fractures have been deformed and caused crooked nose deformities, and it is difficult to restore them with conventional nasal bone reduction methods ^[2] .

Prognosis of nasal fracture

Early treatment of nasal bone fractures can reduce the degree of facial shape changes and residual dysfunction.

References:

1. Edited by Li Xuepei. Otorhinolaryngology. Beijing: Peking University Medical Press, 2011: 397-398.

2. Huang Zhaoxuan, Wang Jibao, editor of Kong Weijia. Practical Otorhinolaryngology Head and Neck Surgery, Beijing: People's Medical Publishing House, 2002: 1142.