What are the common causes of nasal fractures in children. How can you recognize the symptoms of a broken nose in a child. What methods do doctors use to diagnose nasal fractures in pediatric patients.

Understanding Nasal Fractures in Children

A nasal fracture, commonly known as a broken nose, occurs when one or more bones in the nose break due to trauma. While more prevalent in adults, nasal fractures can also affect children, albeit less frequently. The nasal structure in children is more flexible and resilient, making it harder to fracture. However, as children grow older and engage in more vigorous activities, the risk of nasal fractures increases.

Anatomy of the Nose

To better understand nasal fractures, it’s essential to know the basic anatomy of the nose:

• Two nasal bones side by side form the bridge of the nose
• These bones support the upper part of the nose and the cartilage in the lower part
• The nasal septum, made of cartilage and several bones, separates the left and right nasal passages
• The septum includes parts of the ethmoid, vomer, maxillary, and palatine bones

The lower part of the nasal bone is thinner and more susceptible to fractures compared to the upper part.

Common Causes of Nasal Fractures in Children

Nasal fractures in children typically result from trauma to the nose. Various situations can lead to such injuries:

• Falls: Children are prone to falls during play or sports activities
• Contact sports: Activities like football, basketball, or soccer can result in facial injuries
• Weight lifting: Improper technique or accidents during strength training
• Automobile accidents: Impact during car crashes can cause nasal fractures
• Child abuse: Unfortunately, physical abuse can lead to facial injuries, including nasal fractures

It’s important to note that not all nasal trauma results in fractures. Children may experience other nasal injuries, such as septal deviation, without necessarily breaking the nasal bones.

Recognizing Symptoms of Nasal Fractures in Children

Identifying a nasal fracture in a child can be crucial for proper treatment. Common symptoms include:

1. Nosebleed: Often one of the first signs of a nasal injury
2. Swelling: The nose and surrounding areas may become visibly swollen
3. Bruising: Discoloration around the nose and under the eyes
4. Tenderness: Pain when touching the nose
5. Crunching sound: A crackling or crunching noise when touching the nose
6. Breathing difficulties: Trouble breathing through the nose
7. Deformity: Visible changes in the shape or alignment of the nose

In most cases, the injury to the nose is obvious due to these visible symptoms.

Diagnosing Nasal Fractures in Pediatric Patients

When a child presents with a suspected nasal fracture, healthcare providers employ various methods to confirm the diagnosis:

Physical Examination

The primary diagnostic tool for nasal fractures is a thorough physical examination. The doctor will:

• Ask about the circumstances of the injury
• Inquire about the child’s general health
• Examine the nose and surrounding areas, including eyes, jaw, and teeth
• Look for bruising, cuts, and swelling
• Assess any changes in the nose’s appearance
• Evaluate breathing difficulties

Imaging Studies

While not always necessary, imaging studies can be helpful in certain cases:

• X-rays: May be recommended to identify fractures, but not always effective for nasal bones
• CT scans: More detailed imaging that can reveal other facial fractures

It’s worth noting that the best indicator of a nasal fracture is often a visible change in the nose’s appearance or significant breathing difficulties.

Importance of Timely Diagnosis and Treatment

Prompt diagnosis and treatment of nasal fractures in children are crucial for several reasons:

• Proper healing: Early intervention ensures the nose heals correctly
• Preventing complications: Timely treatment can prevent long-term breathing problems or cosmetic issues
• Pain management: Addressing the fracture can help alleviate discomfort
• Identifying additional injuries: The diagnostic process may reveal other facial or head injuries that require attention

Treatment Options for Nasal Fractures in Children

The treatment approach for nasal fractures in children depends on the severity of the injury:

Conservative Management

For minor fractures without significant displacement:

• Rest and careful protection of the nose
• Ice application to reduce swelling
• Pain management with over-the-counter medications

Repositioning

For more severe fractures requiring realignment:

• Closed reduction: Performed within two weeks of injury
• Local or general anesthesia may be used
• The doctor realigns the bones and may use a cast for stabilization

Surgical Intervention

In cases of complex fractures or delayed treatment:

• May be necessary if more than two weeks have passed since the injury
• Usually performed after swelling has subsided (2-3 months post-injury)
• Can involve reconstructive plastic surgery to restore pre-injury appearance

Long-term Considerations and Follow-up Care

After initial treatment of a nasal fracture, ongoing care and monitoring are essential:

• Regular check-ups to ensure proper healing
• Monitoring for potential complications like septal hematoma or persistent deformity
• Assessing the need for future corrective procedures, especially in growing children
• Addressing any long-term breathing issues that may arise

Parents and caregivers should remain vigilant for any signs of complications or changes in the child’s breathing patterns following a nasal fracture.

Preventing Nasal Fractures in Children

While it’s impossible to prevent all injuries, certain measures can reduce the risk of nasal fractures in children:

• Proper safety equipment: Ensure children wear appropriate protective gear during sports and recreational activities
• Supervision: Maintain close supervision during potentially risky activities
• Safe environment: Childproof living spaces to minimize fall risks
• Education: Teach children about safety precautions and the importance of protecting their face during physical activities
• Vehicle safety: Always use appropriate car seats and seat belts

By implementing these preventive strategies, parents and caregivers can significantly reduce the likelihood of nasal fractures and other facial injuries in children.

Understanding nasal fractures in children, from their causes and symptoms to diagnosis and treatment options, is crucial for parents, caregivers, and healthcare providers. While less common than in adults, these injuries can have significant impacts on a child’s health and well-being. Prompt recognition of symptoms, timely medical evaluation, and appropriate treatment are key to ensuring the best possible outcomes. By staying informed and taking preventive measures, we can help protect children from these potentially serious injuries and support their healthy development.

Nasal Fractures – ENT Health

Your doctor will ask you several questions and examine your nose and face. You will be asked to explain how the fracture occurred, the state of your general health, and how your nose looked before the injury (bring a picture to your appointment, if possible). Your doctor will examine not only your nose, but also the surrounding areas including your eyes, jaw, and teeth, and will look for bruising, cuts, and swelling.

Sometimes your physician will recommend an X-ray or computed tomography (CT) scan. These can help identify other facial fractures, but are not always helpful in determining if you have a broken nose. The best way to determine that your nose is broken is if it looks very different or is harder to breathe through.

If your nose is broken but not out of position, you may need no treatment other than rest and being careful not to bump your nose.

If your nose is broken so badly that it needs to be repositioned, you have several options. Your nose can be repaired in the office in some situations. However, many situations require general anesthesia, particularly if the septum has also been damaged. Your doctor can give you local anesthesia, reposition the broken bones into place, and then hold them in the right location with a plastic, plaster, or metal cast. This cast will then stay in place for one week. In the first two weeks after the injury, your doctor may offer you this kind of repair, or a similar approach using general anesthesia in the operating room.

If more than two weeks have passed since the time of your injury, you may need to wait a while before having your nose straightened surgically. It may be necessary to wait two to three months before a good repair can be done, by which time there will be less swelling, and your nose will begin to heal as best it can. Reduced swelling will allow the surgeon to get a more accurate picture of how your nose originally looked. This type of surgery is considered reconstructive plastic surgery, as its goal is to restore your appearance to the way it was prior to injury.

If your repair is done within two weeks of the injury, restoring prior appearance and breathing is the only possible goal. If you have waited several months for the repair, it is often possible to change the appearance of your nose as you desire through combined nasal fracture repair and rhinoplasty procedures.

Nasal Fracture in Children | Cedars-Sinai

Not what you’re looking for?

What is a nasal fracture in children?

A nasal fracture is a break in one
or more of the bones of the nose, caused by trauma. It’s also called a broken nose.

There are 2 nasal bones side by side in the nose. These bones form the bridge of the
nose. They help support the upper part of the nose. They also help support the cartilage
that forms the lower part of the nose.

A nasal fracture is a break in one
of the nasal bones or in one or more of the bones that make up your nasal septum. The
septum separates the left and right sides of your nose. It’s made of cartilage and parts
of several other nasal bones. These are the ethmoid bone, the vomer bone, the maxillary
bone, and the palatine bone.

Nasal fractures are more common in
adults than in children. Children’s nasal bones are harder to fracture. Nasal fracture
is fairly uncommon in young children because they don’t take part in the activities
that can cause a nasal fracture. The risk increases with age. More boys than girls get
nasal fractures. The nasal bone is one of the most commonly fractured bones of the face.
The lower part of the nasal bone is thinner than the upper part and breaks more
easily.

What causes a nasal fracture in a child?

Trauma to the nose causes nasal
fracture. This might come from various sources such as:

• Falls
• Contact sports
• Weight lifting
• Automobile injuries
• Child abuse

Most nasal trauma doesn’t cause
nasal fracture. Many children have other injuries to the nose, like deviation of the
septum.

What are the symptoms of a nasal fracture in a child?

Symptoms of a nasal fracture might include:

• Nosebleed
• Swelling
• Bruising of the nose
• Bruising under the eye
• Tenderness when touching the nose
• Crunching sound when touching the nose
• Trouble breathing out of the nose
• Deformity of the nose

Usually, the injury to the nose is obvious.

How is a nasal fracture diagnosed in a child?

Your child’s healthcare provider
will ask about your child’s health history, and about the details of the trauma. Your
child will also need a thorough medical exam. This will include both an internal and
external exam of the nose. Because nasal fracture often happens with other injury, your
child will need a thorough exam assessing other possible areas of injury, like the eyes
and teeth.

Plain X-rays don’t usually aid in
diagnosis. Your child may need another type of imaging such as CT scan to provide more
information about the damage.

A primary care healthcare provider, emergency room healthcare provider, or pediatrician
(healthcare provider who specializes in children’s healthcare) often makes the first
diagnosis. However, most children need to see an ear, nose, and throat healthcare
provider (otolaryngologist) for treatment.

How is a nasal fracture treated in a child?

Treatment will depend on your child’s symptoms, age, and general
health. It will also depend on how severe the condition is.

Children should sit upright for a
time after the injury, to help reduce swelling and pooling of blood in the nose. Initial
treatment might include pain medicines and ice.

Some children with severe injuries
need to see an ear, nose, and throat healthcare provider immediately. Others will need
to see an ear, nose, and throat healthcare provider after a few days. The delay allows
the swelling to go down, so the healthcare provider can evaluate and recommend further
steps.

Many children need “reduction” of
the nasal fracture as part of their treatment. This just means that a healthcare
provider needs to realign the bones, if they are out of place. Your child might need
this right away or later at a follow-up appointment. Your healthcare provider might do
this by physically moving the bones back into place (“closed reduction”). Less commonly,
surgery is needed (“open reduction”). Because this can be painful, healthcare providers
usually do this when the child is asleep under general anesthesia. After reduction, the
nose usually needs a splint.

After the reduction, your child’s
nose may not look exactly the way it did before. Rhinoplasty surgery (nose surgery) may
help restore a more cosmetic appearance.

If your child’s nasal fracture is
more severe, he or she might need a more complicated surgery immediately after the
injury. Septorhinoplasty can help restore the cosmetic appearance of the nose, as well
as restoring a displaced nasal septum and blocked nasal airway.

What are possible complications of a nasal fracture in a
child?

Nasal fracture in children sometimes results in complications, though your healthcare
team will work hard to prevent these. Your child’s risk for complications may vary
according to age and the extent of injury. Some possible complications include:

• Septal abscess
• Septal hematoma
• Severe nosebleed
• Infection of the brain or tissues around the brain
• Tear duct obstruction
• Abnormal connection between the nasal cavity and the mouth
• Underdevelopment of the maxillary bone (making the middle of the face look
  sunken)
• Cosmetic imperfections

These complications often need
additional treatment, like antibiotics for a septal abscess, or surgical drainage of a
septal hematoma. In infants, nasal fracture can also cause trouble breathing because
infants can’t breathe through their mouths. These children need immediate treatment.

How can I help my child live with a nasal fracture?

After a nasal fracture, the nose needs time to heal. The nose is easy to reinjure
during this time. For this reason, most healthcare providers recommend that children stay
away from all sports for at least 2 weeks. Your child needs to avoid contact sports (like
football or wrestling) for at least 6 weeks.

When should I call my child’s healthcare provider?

Call the healthcare provider if any your child’s nose continues to
bleed, if he or she has a fever or chills, or shows confusion or unconsciousness.

Key points about nasal fracture in children

A nasal fracture is a break in one or more of the bones of the nose, caused by
trauma.

• Falls, sports, and automobile accidents are common causes of nasal fracture.
• Your child may need to have his or her nose put back in alignment, usually under
  general anesthesia.
• Specific treatment for nasal fracture varies according to the nature of the injury,
  how long ago it happened, and other associated injuries.
• Your child may need additional surgery to help restore the nose’s cosmetic
  appearance.
• For several weeks after the injury,
  it’s important to be especially careful not to reinjure the nose.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider
  tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines,
  treatments, or tests. Also write down any new instructions your provider gives
  you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also
  know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or
  procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider if you have questions.

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Baton Rouge Broken Nose (Nasal Fracture)

What is a Broken Nose?

A broken nose, also referred to as a nasal fracture, is a crack, break, or fracture in one of the bones or cartilage of your nose. Broken noses most often occur in the septum, or bridge of the nose (area that divides one nostril from the other).

Causes of a Broken Nose

Most broken noses are the result of some type of impact and they can regularly occur when other injuries to the face or neck happen. The most common causes of broken noses are as follows:

• Contact during sporting events
• Car accidents
• Fighting, getting punched, or kicked in the nose
• Falling down and landing on your face
• Walking into objects such as a wall, tree, or door
• Biking, skiing, snowboarding, skateboarding accidents
• Workplace accidents

Symptoms and Diagnosis of a Broken Nose

Symptoms of broken noses often include:

• A crooked, twisted, bent, or swollen nose
• Pain sensation in the nose
• Nose bleeds
• A congested or stuffy nose that feels like it won’t go away or drain
• Grinding or rubbing noise or feeling when your nose moves
• Bruises in or around the nose and eyes

Diagnosis of a broken nose will typically involve a physical examination, application of anesthetic if you are in severe pain, x-rays, and/or CT scans.

Treatments for a Broken Nose

Severely broken noses may require immediate emergency care, or first air at home followed by visiting your doctor within the next few days.

Home treatment for a broken nose can involve:

• Take over-the-counter pain medications such as acetaminophen or ibuprofen.
• Lean forward while breathing through your mouth so that blood does not drain into your stomach.
• If your nose isn’t bleeding, elevate your head to limit the throbbing or pulsing pain.
• Apply a cold washcloth or ice to reduce swelling

Medical treatment from your doctor may involve the following:

• Placing a splint on your nose
• Packing your nose with gauze to help reduce bleeding
• Manually realign your nose (closed reduction surgery) to the proper position after using a local anesthetic
• Surgical procedures (Rhinoplasty or septorhinoplasty) to repair or realign your nose or nasal septum

First Aid and Treatment for Broken Noses

The nose is the most commonly broken bone in the head. Broken noses are almost always the result of trauma to the face. Symptoms include pain, visible deformity, bloody nose and in severe cases difficulty breathing and bruising around the eyes or “black eyes.” A broken nose can cause a deviated septum.

Jaromir Chalabala / EyeEm / Getty Images

First Aid for Broken Noses

• Breathe through your mouth.
• Do not move if it is possible that there could be damage to your neck or spine. Have someone else call 911.
• If your neck is okay lean forward and gently pinch the nostrils together. This will help to stop the bleeding and prevent blood from running into the back of the throat and being swallowed.
• Apply a cold compress to help control pain and swelling.
• You may use acetaminophen to control pain or a doctor may prescribe something stronger. Inform your doctor of any over-the-counter pain relievers you took before coming to the clinic or ER.

When Is a Broken Nose an Emergency?

All known or suspected broken noses should be checked out by a doctor to rule out serious complications.

Broken noses are a medical emergency if:

• You cannot control bleeding.
• You have difficulty breathing.
• Other serious injuries are suspected, especially injuries of the spine or neck.
• A significant amount of clear fluid is draining from the nose.
• There are large blood clots present.
• The tissue of the nose turns black.

Diagnosing a Broken Nose

It may be surprising to know that x-rays are not particularly helpful in diagnosing and treating broken noses. The diagnosis is typically made based on the appearance of the nose and whether or not you are having difficulty breathing. Medical imaging such as x-rays or CT scans is sometimes done to rule out other fractures of the head or neck, depending on the injury.

Treatment Options for a Broken Nose

Many fractures do not need to be repaired but just need time to heal. Your doctor may recommend light activity, particularly avoiding any activity that could result in a facial injury for about six weeks while the nose heals. You must be very careful during this time that your nose it not bumped or hit.

The bone will be reset only if there is obviously physical deformity, or the fracture is interfering with breathing. If the bone does need to be reset there are a couple of options depending on the situation. In some cases, the bones can be reset in the doctor’s office with a local anesthetic. The bones are then held in place with a cast which remains in place for about a week.

There are some serious complications in the case of broken noses. A septal hematoma (a blood-filled abscess) may form (most often within 24-48 hours of the injury) and if it is not drained in a timely manner can result in tissue death and actually cause the nose to collapse.

Sometimes surgery is necessary to repair these types of problems, in order to reset the bone or repair a deviated septum.

Broken Nose Santa Monica | Nasal Fracture Santa Monica

In cases of facial trauma, nasal fractures are a common type of bone injury. This is largely due to the prominence and central location of the nose on the face and the weakness of the nasal cartilage. A nasal fracture is commonly the result of an injury from a car accident, a fall, a physical altercation, or a sports-related injury. Untreated nasal fractures can negatively affect both the appearance and the function of the nose. Functional problems include chronic nasal obstruction or blockage, and a predisposition for sinusitis, infection, and nosebleeds.

How can I tell if my nose is broken?

Diagnosing a broken nose is as simple as examining the appearance of the nose after a trauma. If the shape of the nose has changed and this change persists after 4-7 days when the swelling from the injury has subsided, then one can be rather certain that the nose has been broken and an ENT should be consulted for treatment options.

Symptoms Of Nasal Fractures

Nasal fractures often go unnoticed by both physicians and patients as a combination of the symptoms, including tenderness, hemorrhaging, and deformity, may not occur for long or at all. Additional symptoms of nasal fractures may include:

• Tenderness
• Swelling
• Difficulty breathing through the nose
• The crooked appearance of the nose
• Bruising
• Nosebleeds
• Pain

Diagnosis Of Nasal Fractures

A nasal fracture is commonly diagnosed by a doctor by reviewing the patient’s symptoms and performing a physical examination of the nose. Additional diagnostic tests may include:

Treatment For A Nasal Fracture

A nasal fracture is immediately treated with ice and pain medications. Nasal decongestants may be prescribed to help make breathing easier while the nose is swollen. In cases where the nasal fracture is only a simple fracture, this may be the only treatment necessary. If the bone or cartilage in the nose needs to be straightened, a doctor may use a splint or fill the area with gauze in the technique known as nasal packing. For a more severe nasal fracture, surgery may be necessary to move the bone or cartilage back into the original position.

After treatment for a nasal fracture, most regular daily activities may be resumed. Patients may be advised to refrain from playing sports or performing strenuous physical activities for a few weeks after the initial treatment. When returning to sports or physical activities, doctors may recommend a nose guard.

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Nose/Sinus/Facial Fractures, Trauma ENT Services in Arizona

Nasal trauma is an injury to the nose or the areas that surround and support the nose. Internal or external injuries can cause nasal trauma.

The position of the nose makes the nasal bones, cartilage, and soft tissue vulnerable to external injuries. Nasal fractures are the most common types of facial fractures; it can be obvious that there is an injury to the nose due to bruising, swelling, and bleeding from the nose, however, they are often unrecognized and untreated at the time of injury and a careful examination is important for anyone who sustains nasal trauma. Bleeding, swelling, blood clots, and fractures can result from injuries to the nasal area. Physical deformity, infections, and obstructed breathing are potential complications of nasal trauma.

Nasal trauma that results in nosebleeds occurs because the nose has many blood vessels positioned close to the surface. This makes them easy to injure.

The nasal sinuses are usually lined with paper-thin bone and thus have a high tendency to sustain a fracture during trauma.  Sinus fractures can lead to a lifetime of sinus disease.  As such, sinus issues should be treated by a facial plastic surgeon that has extensive training in sinus surgery as an otolaryngologist (ENT).

There are several signs and symptoms of a broken nose such as bruising and swelling, bleeding, a crooked misshapen appearance. X-rays and other imaging studies are usually unnecessary. However, your doctor may recommend a computerized tomography (CT) scan if the severity of your injuries makes a thorough physical exam impossible or if your doctor suspects you may have other injuries.
Signs of sinus fracture vary according to the location of the affected sinus.

Fractures of the maxillary sinuses are usually coupled with cheekbone fractures.  In cases of isolated maxillary sinus fractures, you may notice air under the skin of the cheek or notice bleeding during nose blowing.  However, isolated maxillary sinus fractures can easily go undiagnosed, as very few symptoms are associated with them.

Fractures of the ethmoid sinus are almost always associated with an orbital blowout fracture (a fracture of one or more of the bones surrounding the eye) and would be diagnosed and treated accordingly.

When a fracture involves the frontal sinus, you may notice a depression of the forehead.  There may also be some bleeding from the nose.  If the fracture involves the back wall of the frontal sinus it may cause leakage of the fluid surrounding the brain, cerebral spinal fluid (CSF).  This usually manifests as a clear runny nose that worsens with squatting.  It may also feel like salt water is trickling down the back of the throat.

If you think you have a sinus fracture then you should see a specialist to confirm the diagnosis.  This is typically done with a CT scan of the head and can determine if there was any damage to the surrounding structures.

Treatment depends on the type of injury you have.

Nasal fracture

If you have a minor fracture your doctor may recommend simple measures, such as using ice on the area and taking over-the-counter pain medications.

If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them. This is usually successful if done within two weeks from when the fracture occurred, preferably sooner.

An injection or nasal spray is used to  ease discomfort and your physician uses special instruments to help realign your broken bones and cartilage

Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You’ll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose.

Surgery

Manual realignment may not be appropriate for severe breaks or breaks that have gone untreated for more than 14 days and surgery may be necessary to realign the bones and reshape your nose. If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis.

Sinus Fractures

Ethmoid sinus fractures are typically not repaired.  If any repair is needed, it is done in conjunction with an orbital blow out fracture repair.

Similarly, maxillary sinus fractures may also not require repair.  This is especially true if fractured pieces of bone are not displaced.  However, in cases of severe displacement, repair is required.  In these instances repair can be performed through a small incision on the inside of the gum line.  The fractured bones are then placed back into their original locations and secured with thin titanium plates.

Frontal sinus fractures will always require intervention.  If the fracture does not involve the drainage pathway of the sinus and brain, then simple routine follow up with repeated CT scans are all that is required.  However, if the fracture involves the drainage pathway or has caused CSF leakage, the fracture will need to be surgically reduced and plated.

First, the doctor will control your nosebleed (if you have one). If there is a collection of blood inside your nose, called a septal hematoma, the doctor will drain it by cutting a hole in it to let the blood out.

Because your nose will be very swollen at first, a broken nose is not immediately put back into place. Even after the swelling goes down, putting a broken nose back in place is necessary only if you will have a poor cosmetic result or your airflow is obstructed. If it is necessary, a specialist will do it at a follow-up appointment. By this time, the swelling should have gone down, and specialist will be able to put the bone in place more accurately.

Fractures of the bones inside your nose (ethmoid fractures) require hospitalization.

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Nose/Sinus/Facial Fractures, Trauma ENT Treatment in Utah

Nose/Sinus/Facial Fractures, Trauma

Nose/Sinus/Facial Fractures, Trauma – About

Injury to the nose or the areas that surround and support the nose is known as nasal trauma. Both external and internal injuries can cause nasal trauma.

The cartilage, nasal bones, and soft tissue are vulnerable to external injuries, due to the position of the nose. The most typical types of facial fractures are nasal fractures. Due to swelling, bruising, and bleeding from the nose, it can be clear that there is an injury. However, they go regularly unnoticed and untreated during the time of injury and a careful examination is crucial for anyone who sustains nasal trauma. Swelling, bleeding, blood clots, and fractures can be a result from injuries to the nasal area. Potential complications of nasal trauma are physical deformity, infections, and obstructed breathing.

Nasal sinuses have a high tendency to sustain a fracture during trauma because they are typically lined by thinner bone. Sinus fractures may lead to problems such as sinusitis. Facial imaging and ENT evaluation is needed to determine is treatment of sinus fractures is needed.

Nose/Sinus/Facial Fractures, Trauma – Diagnosis

There are multiple symptoms and signs that point towards a broken nose such as swelling and bruising, bleeding, a crooked misshapen appearance. X-rays or CT scans may be needed to assess the severity of fractures. Nasal endoscopy and ENT exam are essential.

Nose/Sinus/Facial Fractures, Trauma – Treatment

Treatment options depend on the type of injury or damage and individual has.

Nasal fracture

If you have an insignificant fracture your doctor may suggest simple procedures, such as placing ice on the region and taking over-the-counter pain medications.

Your doctor may be able to manually realign the cartilage and bones in your nose if the break has displaced them. This is typically successful if performed within two weeks from when the fracture happened, preferably as soon as possible.

To ease discomfort, your physician uses an injection or nasal spray, then your physician uses special instruments to help readjust your broken bones and cartilage. Often, general anesthesia is needed for the surgery, particularly in younger patients.

Your doctor will also splint your nose using packing in your nose and a dressing on the exterior. Occasionally, an internal splint is needed for a short period of time. Typically, the packing needs to stay in for 7 days. A prescription for antibiotics will be administered to you, this will help prevent infection with the bacteria that may normally reside in your nose.

Surgery

If the break has damaged your nasal septum, causing obstruction of the airway or difficulty breathing, reconstructive surgery may be recommended. Manual realignment may not be applicable for severe breaks, or breaks that have gone untreated for more than 2 weeks. If this is the case, surgery may be needed to readjust the bones and reshape your nose. Surgery is usually performed on an outpatient basis.

Sinus Fractures

Often no treatment is needed. More severe sinus fractures may require surgery. Your ENT doctor will discuss your specific needs.

90,000 Algorithms for the diagnosis and treatment of fractures of the nasal bones

© S. A. Semenov, V. S. Kunitsky, 2012

ALGORITHMS FOR DIAGNOSTICS AND TREATMENT OF FRACTURES OF THE NOSE BONES

SEMENOV S.A., * KUNITSKY V.S. **

ME “Vitebsk Regional Clinical Hospital”, *

EE “Vitebsk State Order of Friendship of Peoples Medical University”,

Department of Otorhinolaryngology **

Summary.Diagnosis of a fracture of the nasal bones is based on the data of the clinical and instrumental examination of the patient. Clinically, it is possible to make a diagnosis in only half of the patients who have applied, a rationally selected additional examination algorithm leads to an accurate diagnosis, and allows timely identification of complications of a fracture of the nasal bones. The most common complication of a fracture is deformity of the external nose. The choice of the optimal treatment tactics makes it possible to eliminate the adverse cosmetic and physiological consequences of the injury; adequate anesthesia allows the intervention to be carried out painlessly.The article presents data on the epidemiology, diagnosis and treatment of nasal fractures. Algorithms for diagnostics, treatment tactics, choice of anesthesia technique for fractures of the nasal bones, which ensure the effectiveness of medical measures, are presented.

Keywords: nose, fracture, reduction, rhinoplasty, algorithm.

Abstract. Diagnosing of nasal bones fractures is based on the patient’s clinical and instrumental examination data.By means of clinical method the diagnosis becomes possible only in 50% of the admitted patients. Correct diagnosing requires an adequate algorithm of instrumental investigation to timely reveal complications development. The most frequent complication of nasal bones fracture is external nose deformation. Optimum treatment tactics choice helps to avoid unfavourable cosmetic and physiolological consequences of the trauma. Proper anesthesia enables painless surgical intervention. This review contains the epidemiologic data, diagnostic and surgical approaches associated with nasal bone fractures.Diagnostic algorithms, variants of treatment, the choice of anesthesia providing the efficacy of medical care are also discussed.

Fractures of the nasal bones (NNF) are the most common trauma to the facial skeleton and ENT organs [1, 2], the reason for referring to an otorhinolaryngologist for urgent and urgent indications. Establishing an accurate diagnosis is necessary for

Address for correspondence: 210023, g.Vitebsk, Frunze Ave., 27, Vitebsk State Medical University, Department of Otorhinolaryngology, tel. 8 (0212) 22-40-01 – Kunitskiy V.S.

determination of treatment tactics, issuance of a reliable conclusion.

To clarify the diagnosis in many medical institutions there is a large selection of diagnostic equipment (devices for X-ray, CT, MRI, ultrasound and endoscopic examination).A rationally selected research algorithm leads to a timely diagnosis, adequate and full-fledged therapeutic measures, and ensures economic efficiency.

Restoring the shape of the external nose is an especially important task, because the adverse effects of the trauma in a cosmetic respect, in some cases, can lead to mental disorders in the victims; there are professions for which the favorable appearance of the employee is important [3].Deformation of the external nose, developed displacement of the nasal septum lead to difficulty breathing through the nose [4]. Disturbed nasal breathing negatively affects the functions of both the nose itself and organs and systems distant from it [5]. Information about the timing of the operation, instruments and techniques of surgical correction, methods of fixation of bone fragments during restoration of the shape of the nose after trauma are variable and sometimes contradictory. Most authors [1, 6] advise to restore the shape of the nose in the early stages after injury – during the first week, when tissue edema does not interfere with determining the nature of the deformity, and connective tissue scars have not yet formed.So, Shcherbina E.V. [7] advises to carry out the reposition of bone fragments immediately when the patient seeks medical help, in the future, after the disappearance of the edema, the existing deformity can be corrected, if necessary. The maximum allowable time for the reposition of the nasal bones is quite variable – from one to four weeks after injury [1, 6, 7, 8]. When examining patients with persistent deformities of the nose in the long term after reposition of the nasal bones, it was found that in all cases it was only possible to improve the shape of the external nose [9].In recent years, closed rhinoplasty and rhinoseptoplasty techniques have been used for the treatment of patients with PCI according to indications [10, 11, 12]. Simultaneous rhinoseptoplasty is an expedient surgical tactic for the treatment of patients with deformity of the nose and deviated nasal septum, because the results of cosmetic surgeries on the external nose and surgeries on the nasal septum are interdependent, and the surgical intervention should restore the aesthetic at once

and the respiratory function of the nose [13].The choice of the optimal treatment tactics remains an unresolved problem. The methods of anesthesia are being improved along with the development of pharmacology and anesthesiology. Thus, the development of optimal algorithms for the diagnosis and treatment of patients with fractures of the nasal bones, taking into account the development of modern medicine, is urgent.

The purpose of this work is to develop optimal algorithms for the diagnosis and treatment of patients with fractures of the nasal bones.

Methods

The study included patients with PCI who were examined, were treated in the health care institution “Vitebsk Regional Clinical Hospital” in 2005-2012 outpatient or inpatient.

To determine the epidemiological features, a retrospective analysis of the attendance rate of 573 patients with PCI at the Healthcare Institution “Vitebsk Regional Clinical Hospital” was carried out.The journals of the admission department (form No. 1) and cards of inpatients of the otorhinolaryngological departments for adults and children of the VOKB for 2009 were studied. The composition of patients was studied by age and sex, place of residence, causes of injury, presence of concomitant pathology, distribution by months of the year.

To establish or confirm the diagnosis of PCI, after collecting anamnesis, examination, palpation of the external nose, anterior rhinoscopy were performed, then x-ray of the nasal bones, computed tomography (CT), and ultrasound examination (ultrasound) of the nasal bones were performed.Radiographs of the nasal bones of the patients were performed using the Kosmos-330 apparatus (Drive assembly, Belarus, Ralco-Sedecal, Italy-Spain) in lateral and direct occipital-chin projections. Nasal CT was performed using a spiral computed tomography “Somatom emotion” (manufactured by “Siemens”, Germany) in two projections: in most cases in the axial, sometimes in the coronary with a step of 5 mm, followed by

two-dimensional reconstruction.Ultrasound examination of the nasal bones was carried out on a Voluson 730 Expert apparatus (manufactured by Kretz-GE, Austria-Germany-USA) with a linear-trapezoidal transducer with a working surface length of 40 mm and a frequency of 6-12 MHz in the patient’s supine position. The sensor was first installed longitudinally (parallel to the nasal dorsum) and transversely on the nasal dorsum, and then longitudinally and transversely on both slopes of the nose, to make the surface of the sensor and nose congruent, a gel was applied to the nasal skin.

Patients with PCI with deformity of the external nose underwent surgical treatment: reduction of the nasal bones, early closed rhinoplasty or rhinoseptoplasty.For reposition of the nasal bones, the technique proposed by Yu.N. Volkov. We used a Volkov elevator to raise the sunken slope of the nose, external finger pressure to eliminate lateral displacement. If the pyramid of the nose was not installed in the midline, if the fracture was more than 7 days old or if there was a history of persistent post-traumatic deformity of the nose, a rinoclast was additionally used. Rhinoplasty and rhinoseptoplasty were performed according to the original technique, taking into account the techniques described in the literature [10, 15].For rhinoseptoplasty, septoplasty was first performed. The restoration of the shape of the external nose began with an endonasal interchondral incision on the side where the pyramid of the nose was displaced. Detachment of soft tissues and periosteum was performed above the pyramid of the nose, then with the help of a Volkov elevator (or a spatula), finger pressure, rhinoclast, chisels, the pyramid of the nose was installed in the midline, the sunken slope of the nose was raised. The operation was completed with a tamponade of the nasal cavity and the imposition of an external plaster cast.A gauze turunda soaked in Mekol ointment was injected into the upper sections of the nasal cavity under the nasal bones; rubber-gauze tampons with respiratory canals were inserted into the lower sections of the nasal cavity. Rubber-gauze tampons were removed 24-48 hours after surgery, turunda from the upper sections of the strips –

noses – after 3-4 days, the plaster splint was removed for 5-7 days. The function of nasal breathing was assessed using the Rinolan medical device.”Rinolan” is a computer rhinomanometer (analogue of LTM08-200), which allows examination according to the method of anterior active rhinomanometry.

Anesthesia techniques were used to restore the shape of the nose:

1. Local application anesthesia on the mucous membrane of the nasal cavity with 10% lidocaine hydrochloride solution. 2. Local application anesthesia with 10% solution of lidocaine hydrochloride and infiltration and conduction anesthesia 10-20 ml 1-2% solution of lidocaine or 1-2% solution of novocaine.3. Intravenous anesthesia with propofol (or sodium thiopental). 4. Intravenous anesthesia combined with local application anesthesia. 5. Intubation endotracheal anesthesia. 6. Intravenous anesthesia combined with local application and infiltration anesthesia. For a subjective assessment of the surgery, patients were asked to fill out a questionnaire, in which, on a 4-point scale, fear before surgery, pain during and after surgery were noted.

Results and discussion

573 visits of patients with PCI in 2009 were analyzed, of which 430 (75.04%) care was provided on an outpatient basis, 143 (24.96%) were hospitalized.Outpatients with PCI accounted for 13.38% of all outpatients who consulted an otorhinolaryngologist, patients with PCI made up 3.01% of all patients treated in otorhinolaryngological departments of the UZ “V OKB” in 2009. Among the patients with PCI, men predominated – 418 (72.95%), there were 155 females (27.05%). The average age of those who applied was 30.11 ± 14.65 years (minimum age 1 year, maximum age 94 years). The largest number of patients were in the age group 16-30 years old – 302 (52.71%) patients (Fig.one). The number of patients with PCN who applied

Number of 100 patients

80

5 and 6- 11- 16- 21- 26- 31- 36- 41- 46- 51- 56- 61- 66- 71 <10 15 20 25 30 35 40 45 50 55 60 65 70 and>

Age (years)

and women

і men

Fig.1. Distribution of patients by age and sex.

Number

patients

70

60

50

40

30

20

10

About

G

Fig.2. Distribution of patients by months of the year.

by months of the year is shown in Figure 2. Among the causes of PCI, domestic criminal trauma was in the first place – in 260 (45.38%) people. Among other causes of PCI in 2009, there were the following types of injuries: household non-criminal – in 185 (32.29%) applicants (as a result of falls in a state of alcoholic intoxication, falls of the elderly, during a game, and other accidental injuries), during a lesson sports – at 23

(4.01%), as a result of a traffic accident – in 7 (1.22%), industrial – in 2 (0.35%), the circumstances of the injury were not reported in 96 (16.75%) patients.Most often, PCI was combined with injuries to the skin of the nose (in 91 patients – 15.88%), bruises of the soft tissues of the face and bruising of the eyelids. Of the 319 people who applied for medical care during the first day after the injury, 173 (54.23%) were in a state of

0

alcoholic intoxication. The most common reason for hospitalization of patients in the otorhinolaryngology department was a fracture of the nasal bones with deformation of the external nose, when general anesthesia was used to reposition the nasal bones (104 patients – 18.15%).Among other reasons for hospitalization, it is necessary to note a PCI complicated by a hematoma or abscess of the nasal septum (3 patients – 0.52%), with profuse post-traumatic nosebleeds (4 patients – 0.70%), the presence of an open PCI with a nasal skin wound (9 people – 1.57%), PCI complicated by osteitis of the nasal bones (1 patient – 0.18%).

Analysis of clinical symptoms was carried out in 132 patients with PCI, of which 99 (75%) were examined on an outpatient basis and 33 (25%) were examined inpatiently, 102 males (77.27%), females – 30 (22.73%) , average age 29 years (29.22 ± 12.67).The duration of injury in 93.18% (123) patients ranged from several hours to 3 days, 78.94% (91) were examined during the first days after injury. The symptom of crepitus of bone fragments was detected in 25 (18.94%) patients, the mobility of the nasal pyramid – in 18 (13.64%). Deformity of the external nose was noted in 63 (47.73%) patients, but 9 (6.82%) noted that they had deformity after a previous trauma in the anamnesis, 10 (7.58%) people reported a previous fracture nose without deformation. When determining crepitus of bone fragments, mobility of the pyramid of the nose, appearance or increase in deformity of the external nose, clinically diagnosed PCI in 73 (55.30%) patients.Using lateral radiographs of the nasal bones, it was possible to identify PCN in 125 (95.42%) of 131 examined patients. In 6 (4.58%) patients with clinical signs of PCI and deformity of the external nose, when one of the nasal slopes was retracted, no fracture was detected on lateral radiographs. A direct occipital-chin projection (Waters view) was used to assess lateral displacement of fragments or to confirm signs of a fracture not diagnosed at

lateral radiographs, so of 8 patients, the frontal projection revealed a fracture only in 4 (50%) patients with significant displacement of fragments.With a slight displacement of the fragments due to the overlap of bone structures, a displaced fracture could not be visualized. Among 60 studied patients with PCI, ultrasound was able to determine or confirm the presence of a fracture in 58 (96.67%). On ultrasound, the PCN was not visualized in only 2 (3.33%) people; on lateral radiographs in these patients, a fracture was not detected in 12 (20%) people (p <0.05). In 8 (66.67%) of 12 patients, when the fracture was not detected on lateral radiographs, there was a deformation of the external nose in the form of a retraction of the lateral slope of the nose in the region of the frontal process of the upper jaw; in all these patients, the fracture was detected by ultrasound of the nose.Computed tomography of the skull was performed if there was a suspicion or presence of a combined fracture, when, in addition to the nasal bones, the walls of the paranasal sinuses, orbits, and the base of the skull were damaged, or in the presence or suspicion of traumatic brain injury. Such patients were examined jointly by an otorhinolaryngologist, neurosurgeon, maxillofacial surgeon, and ophthalmologist. CT scan clearly revealed the fracture lines of the nasal bones, made it possible to diagnose displacement of fragments, and two and three-dimensional reconstruction presented a pyramid of the nose with existing injuries.A CT scan of the nasal bones of 20 patients with PCI was performed, including 19 men (95%) and one woman, the average age of the examined was 35 years (35.35 ± 11.30), all of them had a fracture confirmed. The diagnostic algorithm is shown in Figure 3.

The study to assess the effectiveness of the treatment included 188 patients aged 15 to 68 years (34 women – 18.09%, 154 men – 81.91%) with a fracture of the nasal bones with deformity of the external nose, who were treated at the UZ ” VOKB “from 2005 to 2012.The average age of the treated patients was 28 (27.96 ± 10.36) years. The most common deformity of the external nose was lateral displacement of the pyramid of the nose with the retraction of one of the

Nose contusion, PCN?

1 G

Clinical examination

Symptoms of PCI No symptoms of PCN

Combined

X-ray of the nasal bones

X-ray of the nasal bones

No

symptoms

PKN

Yes

symptoms

PKN

Yes

symptoms

PKN

No

symptoms

PKN

Ultrasound of the bones of the nose

No Yes

symptoms symptoms

PKN PKN

CT of the skull

Symptoms of PCN

1 g PCN, Nose contusion,

treatment depending on availability otorhinolaryngo observation –

log complications at the place of residence,

additional examination according to indications

Fig.3. Algorithm for examining a patient with suspected PCN.

nasal slopes – there were 164 (87.23%) patients, and the prevailing displacement of the pyramid of the nose to the right with retraction of the left slope of the nose – in 100 (53.19%) patients. All patients were

underwent surgery to restore the shape of the external nose. Depending on the surgical technique used, the patients were divided into

Lena for 2 groups.The first group included 143 patients who underwent reduction of the nasal bones. The second group included 45 patients, in whom the restoration of the shape of the external nose was performed by the type of early closed rhinoplasty or rhinoseptoplasty. The criteria for the inclusion of patients in the second group were: a fracture with a prescription of 14 or more (up to 45) days after injury, a repeated fracture with a persistent post-traumatic deformity of the external nose in history (deformity of the nose increased after the last injury), a fracture less than 14 days old with a displacement of the nasal septum and the ineffectiveness of the previous reduction of the nasal bones.Of the 143 patients of the first group, it was possible to restore the shape of the nose in 119 (83.22%) people, in 24 (16.78%) people, the shape of the nose was only improved. Among the patients of the second group, it was possible to restore the shape of the nose in 42 (93.33%) of 45 people. For comparison, in patients of the first group (who underwent reposition of the nasal bones) with an injury of 14 days or more, a history of persistent post-traumatic deformity of the external nose, it was possible to restore the shape of the nose only in 3 (12.50%) of 24 patients (p <0.0001). During rhinoseptoplasty, pronounced curvature of the nasal septum was eliminated, which could not be associated with the last injury, which could not be done with the usual reduction of the nasal bones.

Conducting rhinomanometry before and after surgical treatment in 21 patients of the second group confirmed a significant improvement in nasal breathing: the total flow rate in both halves of the nose increased at a pressure of 150 Pa during inhalation and exhalation (by 312 ± 304 ml / s and 248 ± 246 ml / s respectively), the total resistance on inspiration and expiration decreased (by 2.53 ± 6.24 Pa / ml / s and by 2.44 ± 4.89 Pa / ml / s). Patients of the first group in the presence of difficulty in nasal breathing due to displacement of the nasal septum of the nose, were recommended septumplasty in a planned manner.The algorithm for treating patients with PCI with deformity of the external nose is shown in Figure 4.

The choice of anesthesia technique for reposition of the nasal bones was carried out in 158 patients aged 15 to 67 years (30 women, 128 men) with PCN with deformity of the external nose. The average age of the treated patients was 28 (28.13 ± 10.62) years. When using local anesthesia, only 11 out of 63 (17.46%) patients noted a high degree of pain relief during the intervention, in 31 (49.21%) patients the pain was insignificant (rather unpleasant than painful), in 20 (31.74%) – moderate, one (1.59%) patient indicated that the pain was severe.In subsequent operations of this type, 6 out of 63 (9.52%) people would prefer general anesthesia. With deformation of the external nose in the form of a displacement of the pyramid with a retraction of the nasal slope, the best analgesic effect was achieved with the combined use of application and infiltration-conduction anesthesia in 27 patients (mean pain score 1.04) than with the isolated use of application anesthesia in 16 patients (mean pain score 1.81), the differences between methods # 1 and # 2 are statistically significant pMapp-Whitney = 0.0014.However, when using application anesthesia in 18 patients with isolated retraction of one of the nasal slopes, without displacement of the nasal pyramid and nasal septum, only 2 out of 18 (11.11%) noted moderate pain during the intervention, in 16 (88.89%) pain was insignificant , or not (average pain score 0.78), all 18 people in subsequent operations of this type would choose local anesthesia. When carrying out the reduction of the nasal bones under anesthesia (methods No. 3 and No. 4), 45 out of 55 patients (81.82%) noted the painlessness of the intervention, in 8 people (14.55%) the pain was insignificant, in 2 (3.63%) – moderate.In subsequent operations of this type, 54 out of 55 (98.18%) people would prefer general anesthesia. The combination of intravenous anesthesia with local application anesthesia (method No. 4) helped to ensure the patient’s calm behavior at the final stage of the operation – nasal tamponade, when

Fig. 4. Algorithm for the treatment of patients with fractures of the nasal bones with deformation of the external nose.

, the effect of general anesthesia was already decreasing, the patient was awakening.There were no differences between the methods according to the results of the questionnaire, pMapp-Whitney = 0.6862. Preliminary anemization of the nasal mucosa, a short time interval for surgical intervention, and the use of an electric suction avoided aspiration of blood and oropharyngeal secretions by patients. Thus, the reposition of the nasal bones under intravenous anesthesia was less painful than under local anesthesia, average pain scores were 0. LNey <0.0001.LNey = 0.0264). When the operation was performed by the type of early closed rhinoplasty or rhinoseptoplasty, methods No. 5 and No. 6 were used. All 28 patients operated on under intubation endotracheal anesthesia noted

high analgesic effect (average value of pain in points during surgery -0). Method # 6 was used in 12 patients. Three out of 12 (25%) interviewed patients noted moderate pain during the operation, 7 (58.33%) regarded the pain as insignificant, 2 patients (16.67%) indicated the painlessness of the intervention (the average value of pain in points during the operation was 1.08), 5 (41.67%) patients would prefer endotracheal anesthesia after surgery.LNey = 0.3921 and pMann-Whitney = 0.0925, respectively).

It should be noted that all treated patients in the early postoperative period were satisfied with the result of the operation. Algorithm for choosing anesthesia technique (Fig. 5).

Conclusion

1. Considering that the leading cause of PCI is criminal injury (45.38%), and it is clinically possible to diagnose PCI in only half (55.3%) of patients, additional instrumental examination is necessary.Lateral x-ray of the nasal bones is an affordable, effective method for diagnosing fractures in the nasal dorsum (nasal bones), it is advisable to use it for screening examination of patients with nasal injuries. Ultrasound of the nasal bones is a more accurate method for diagnosing PCI in the area of ​​the lateral slopes of the nose in comparison with radiography (p <0.05), it allows documenting the lateral displacement of fragments. Computed tomography is the most accurate research method, indispensable for the diagnosis of combined skull fractures.

2. Most of the patients with PCI (52.71%) are young people, able to work –

years of age, 16-30 years old, who, in case of deformation of the nose, need to restore the shape of the external nose and nasal breathing. The tactics of early reduction of the nasal bones should be followed. In patients with a fracture of 14 days or more, as well as in the presence of a history of persistent post-traumatic deformity of the external nose, the reposition of the nasal bones in most cases (77.5%) improves the shape of the nose, but does not restore it, use in this category of patients in acute During the period of trauma, the methods of rhinoplasty and rhinoseptoplasty can increase the effectiveness of treatment (up to 93.33%), avoid repeated interventions and hospitalizations (p <0.0001).

3. Intravenous anesthesia during the reposition of the nasal bones makes it more likely (p <0.0001) to perform the intervention painlessly and is the method of choice in the treatment of emotionally labile patients and children. It is advisable to combine intravenous anesthesia with local application anesthesia of the nasal mucosa. It is recommended to use local anesthesia for fresh fractures in adults; moreover, when the bony pyramid of the nose is displaced, it is more effective to use a combination of application, infiltration and conduction anesthesia (p = 0.0014).In case of fractures of the nasal bones with retraction of the clivus without displacement of the pyramid of the nose and the nasal septum, it is permissible to use only application anesthesia. Endotracheal anesthesia provides painlessness of the intervention (p <0.0001), it is recommended when the operation is performed as an early closed rhinoplasty or rhinoseptoplasty.

4. The proposed algorithms should make it easier for doctors to choose the most appropriate sequence of actions in the examination and treatment of patients with PCI.

Literature

1. Nikolaev, M.P. On the tactics of treating injuries of the facial skeleton / M.P. Nikolaev // Vestn. otorhinolaryngology. – 1999. – No. 1. – S. 28-30.

2. Kim, M.G. The use of bioabsorbable plate fixation for nasal fractures under local anesthesia through open

Fig.5. Algorithm for choosing anesthesia technique for reposition of the nasal bones.

lacerations / M.G. Kim [et al.] // J. Plast. Reconstr. Aesthet. Surg. – 2008. – Vol. 61, No. 6. – P. 696-699.

3. Rusetsky, Yu.Yu. Objective computer analysis of aesthetic disorders and assessment of the effectiveness of their correction in nasal fractures / Yu.Yu. Rusetsky // Ros. rhinology. – 2007. – No. 1. -S. 19-23.

4.Rybalkin, S.V. Surgical treatment of nasal septum fractures in children in the acute period of trauma / S.V. Rybalkin, E. Yu. Maslov // Vestn. otorhinolaryngology. – 2003. – No. 3. – S. 32-34.

5. Dzhandayev, S.Zh. Rhinocardial relationships in patients with traumatic nasal disease / S.Zh. Dzhandayev // Medicine. – 2005. – No. 6. – S. 46-48.

6. Kozeltsev, A. L. Fractures of the zygomatic bone, zygomatic arch and nasal bones: method.recommend. / A.L. Kozeltsev; University of Friendship of Peoples. P. Lumumba. – M., 1982 .– 42 p.

7. Shcherbina, E.V. Traumatic injuries of the nose and methods of their treatment: author. dis. … Cand. honey. Sciences: 14.00.04 / E.V. Shcherbina; Kiev. Honey. Institute named after Acad. A.A. Bogomolets. – Kiev, 1965. – 13p.

8. Ignatieva, E.L. On the timing of the open reposition of the nasal bones / E.L. Ignatieva [et al.] // Ros.rhinology. – 2007. – No. 2. – S. 89.

9. Fefilova, V.N. Fractures of the bones of the nose in adults and children: author. dis. … Cand. medical sciences: 777 “Surgery” / V.N. Fefilova; Leningrad. state in-t improved.

doctors named after CM. Kirov – Leningrad, 1968. – 15 p.

10. Rusetsky, Yu.Yu. Surgical tactics for fractures of the nasal bones with an unfavorable clinical course / Yu.Yu. Rusetsky, I.O. Chernyshenko // Ros. otorhinolaryngology. – 2007. – No. 4. – S. 54-60.

11. Palchun, V.T. One-stage septoplasty and re-

position of the nasal bones in the acute period of injury / V.T. Palchun, M.M. Magomedov, E.V. Surikov // Plastic surgery: materials of the National Congress, Moscow, June 8-10, 2011. / Russian Academy of Sciences, Russian Society of Plastic, Reconstructive and Aesthetic Surgeons; ed.E.R. Lavrova. – M., LLC “Publishing House” Bionica “, 2011. – S. 89-90.

12. Femandes, S.V. Nasal fractures: the taming of the shrewd / S.V. Fernandes // Laryngoscope. – 2004. -Vol. 114, No. 3. – P. 587-592.

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Received 29.08.2012 Accepted for publication 05.09.2012

90,000 Rhinoplasty in Novosibirsk at competitive prices

Modern plastic surgery of the nose allows you to aesthetically correct or restore the shape and size of the nose.

Each person is an individual in the broadest sense of the word. This statement also applies to appearance. The human face is unique, it fully reflects the inner “I”. But sometimes there is some dissatisfaction with our reflection in the mirror.This is understandable, since any person always strives for excellence.

The essence of this operation is reduced to the correction of cartilage and bone tissue, which can be performed in two ways. It depends on the specific task facing the surgeon. The first method, closed rhinoplasty, involves an incision in each nostril from the inside (inside the nose). The second method is based on an external skin incision of the nasal septum. But do not be immediately scared, because the traces from the incisions are barely distinguishable, and when using the closed rhinoplasty method, they are not visible at all.

The procedure lasts on average about 2-3 hours. This surgery is performed under general anesthesia – anesthesia, and the additional use of a local anesthetic is also possible. It is important to know here that the choice of anesthetic drugs and the choice of the operation scheme are always carried out depending on your individual characteristics.

Indications for rhinoplasty of the nose

One should think about correcting the shape of the nose from the age of eighteen, since until this moment the nasal cartilage has not yet been fully formed.This plastic surgery is necessary if there are congenital or traumatic deformities of the nose that severely obstruct breathing. If rhinoplasty is performed for aesthetic purposes, then the recommended indicators for carrying out may, for example, be a hump on the bridge of the nose, dilated nostrils, a thickened or long nose.

Contraindications

Rhinoplasty is not prescribed for people with acute and chronic diseases of the upper respiratory tract, hemophilia, diabetes mellitus and cancer.If you have chosen a good clinic, then you will definitely be assigned a full examination. And if the results of the examination are unsatisfactory, then you will be denied the operation.

What else you need to know about this operation

Let’s say you have already finally decided that you need to undergo plastic surgery of the nose. Also, you should understand that rhinoplasty is still a surgical operation. Therefore, the experience and professionalism of the surgeon is extremely important. As practice shows, highly qualified doctors, for the most part, practice in good and large medical centers.

After the operation, during the recovery period, you will have to wear a bandage for 8-10 days. Also, bruises under the eyes persist for 14 days. Within three to four months, there will be little reporting, although it is barely noticeable.

Most often, after a couple of weeks, the nose will take on a normal appearance. After the direct operation, a rehabilitation period follows.

The equipment of the medical center is also an important factor.Because to accelerate the rehabilitation period, you may need the help of physical and UHF therapy, massage, magnetic laser therapy and electrophoresis.

The patient can judge the results of rhinoplasty after 6-7 months. This is due to the fact that during this period, the cartilage tissues are restored and rebuilt. The final result can be seen in about 12 months. In conclusion, I would like to add that for some people this operation brings greater confidence and self-esteem to life.

Frequently asked questions on ENT

How is a polyp removed (loop, laser, shaver)?

We remove polyps under the control of an endoscope using a shaver, the laser is not used in our clinic, as it burns the mucous membrane. The cost of the operation depends on the form of polyposis rhinosinusitis, the volume of operations on the paranasal sinuses, and the correction of predisposing causes.

How can chronic tonsillitis be cured?

Chronic tonsillitis can be cured once and for all only by removing the tonsils.If conservative therapy does not give an effect and there are signs of decompensation: tonsillitis more than 2 times a year, prolonged weakness, fever, inflammatory changes in the blood, complications in the kidneys, heart, then the tonsils must be removed, since they do not perform their functions, but serve as a source infections for the body.

What to do if ringing in the ear persists after otitis media?

Most likely, we are talking about sensorineural hearing loss. Consultation of a neurologist is required to exclude osteochondrosis of the cervical spine.Treatment is prescribed by an audiologist. Usually, courses of vascular, metabolic therapy are carried out in a hospital, followed by taking pills.

Can snoring become chronic and what are the ways to stop snoring?

Snoring is a multi-cause disease, therefore it is necessary to find out what predisposing factors influence snoring. What is the reason for the aggravation of snoring: with age, weight gain, etc.? Snoring itself is not dangerous, but if there is respiratory arrest during sleep, you need to consult an ENT doctor.Treatment for snoring depends on the individual. Someone just needs to lose weight, while someone needs a complex operation. Snoring pills don’t help.

How to correct a deviated septum after a displaced nasal fracture?

Surgically, it is possible to improve the shape of the nose and restore nasal breathing. The operation is called rhinoseptoplasty, it takes place under anesthesia in an open way, in a hospital, as a rule, you need to stay for 3-5 days.A plastic splint is put on the nose. Swelling, bruises disappear within 2-3 weeks. It must be said that after an injury, a perfectly straight nose is rarely obtained; slight asymmetry may remain. The severity of the residual curvature depends on the degree of the initial curvature of the nasal septum. In rare cases, nosebleeds may occur after surgery.

What to do if a maxillary sinus cyst is diagnosed?

Cysts of the maxillary sinuses are of different origins.If the cyst has arisen as a result of impaired ventilation of the paranasal sinus, for example, with a deviated nasal septum, hypertrophy (enlargement) of the turbinates and other conditions, they are corrected at the same time. If the cyst of the maxillary sinus bothers (pain, heaviness in the buccal region, periodic suppuration, etc.), it must be removed under the control of endoscopic technique. In military personnel, pilots, divers, cysts must be removed, even if they do not manifest themselves clinically.If the cause of the cyst is both a curved nasal septum and affected teeth, we recommend one-stage surgical treatment: correction of the nasal septum, endoscopic removal of the cyst and intervention on the teeth, depending on the degree of their damage, under anesthesia.

Do you have an operation to close the opening in the nasal septum?

Perforation should be treated if symptoms such as bleeding or crusting are present, indicating incomplete healing of the edges of the hole.There are two methods of treatment – conservative and surgical. If the perforation does not bother in any way, it is not recommended to touch it: surgical treatment is not effective enough, since the blood supply and nutrition of the mucous membrane are disturbed in the perforation zone. Therefore, the operation to close the perforation often leads to the reoccurrence of perforations of even larger sizes.

Broke my nose a year ago, due to this, breathing was disturbed, every two to three hours I spray into my nose with a spray “Tizin” (xylometazoline 0.1%).Can there be any consequences from this drug when used throughout the year and how much the operation will cost, it is important that the nose functions.

Prolonged use of any vasoconstrictor drugs leads to addiction to them and the occurrence of medication rhinitis. In addition, with their frequent use, they are absorbed into the body and side effects appear, which you can read about in the instructions.
Surgical treatment of the consequences of nasal injuries can be different: elimination of the curvature of the nasal septum, external nose, reduction in the size of the inferior turbinates, expansion of the nasal valve and others.Even if the patient is worried about only bad nasal breathing, and not the curvature of the nose itself, sometimes it is necessary to do an operation on the external nose and the nasal septum at the same time, since the correction of only the nasal septum will not lead to a good result.

Before the operation, it is necessary to carry out computed tomography of the nose and paranasal sinuses. An in-person consultation with an ENT doctor is desirable, making an appointment by phone. (343) 228-28-28.

You can send us photographs of the nose in frontal view, in profile and with the head thrown back so that the nostrils are visible, as well as the results of computed tomography to determine the approximate volume of the operation.Photo requirements here.

How effective are modern surgical treatments for vasomotor rhinitis? Correcting the nasal septum can cause vasomotor rhinitis? If so, is the operation always effective in such cases?

Modern methods of treatment of chronic vasomotor rhinitis are highly effective. In rare cases, when the nasal septum is corrected, a transient vasomotor reaction of the vessels of the inferior turbinates may occur. This is due to the fact that the air flow passing through the nasal cavity after the correction of the nasal septum becomes stronger in comparison with the initial one (before the operation) and leads to irritation of the inferior turbinates.In addition, after the correction of pronounced deformities of the nasal septum, air begins to better penetrate into the paranasal sinuses, which can lead to an increase in the production of mucus by the glands of the mucous membrane inside them. In our opinion, these are transient changes that, as a rule, go away on their own within 6-12 months after the operation.
The effect of surgical treatment of chronic vasomotor rhinitis depends on many factors that can be identified when examining a particular patient.Sometimes vasomotor rhinitis can be accompanied by allergic rhinitis, so additional diagnosis is necessary.

Curvature of the nasal septum

The nasal cavity has the shape of a prism. In the middle of the nasal cavity, there is a vertical formation that divides it into two halves: right and left. This formation is the nasal septum. It consists of the anterior cartilaginous and posterior bone sections. The bony section is formed by the perpendicular plate of the ethmoid bone and the vomer, the cartilaginous – by the quadrangular cartilage.Curvature of the nasal septum as a pathology is widespread throughout the world. Curvature has almost 90% of the adult population.

Depending on the cause of the curvature of the nasal septum, they are subdivided into:

• physiological;
• traumatic;
• compensatory.

Physiological curvatures occur during the growth and development of the organism. They arise as a result of uneven growth of the bone and cartilaginous parts of the nasal septum; T.That is, advancing the growth of one part of the septum of the other. This is the most common cause of curvature of the nasal septum.

Traumatic curvatures occur as a result of mechanical damage (bruises, fractures) and can be very diverse. In the process of growth and development of the bones of the facial skull, even a minor injury to the nasal septum can lead to damage to the growth zones and its further improper formation.

Compensatory – the result of exposure to any irritating factors (polyp, foreign body).

Curvature of the nasal septum is manifested by the following symptoms:

1. Difficulty in nasal breathing.

Until a certain point, a person with a curvature of the nasal septum may not complain of shortness of breath and lack of air until “compensatory” hypertrophy of the turbinates (intranasal structures) occurs in the opposite half of the nose, leading to a narrowing of the lumen of the nasal passage of the “healthy half of the nose.”

2.Chronic rhinitis.

Due to the constant functional overload of one of the halves of the nose with a curvature of the nasal septum, after a few years, chronic rhinitis develops in the wider half of the nose, leading to hypertrophy of the mucous membrane and an increase in the formation of mucus flowing into the nasopharynx.

3. Chronic inflammatory diseases of the paranasal sinuses.

Each sinus opens into the nasal cavity with its opening (anastomosis).Hypertrophy of the intranasal structures leads to a narrowing of the outlet from the sinus and a disruption of the normal outflow of mucus from it, as well as a sufficient supply of oxygen inside. The attachment of the bacterial flora leads to purulent inflammation of the paranasal sinuses. Acute or exacerbation of chronic sinusitis 4-6 times a year is an indication for surgery on the nasal septum.

4. Dryness in the nasal cavity, nosebleeds are possible.

Reflecting from the protrusions, ridges and spines of the nasal septum, the air flow during inhalation and exhalation creates excessive pressure on the nasal mucosa, which leads to drying, dystrophic changes and thinning of the mucous membrane, as well as increased fragility of blood vessels and bleeding.

5. Decreased sense of smell.

The curvature of the nasal septum can obstruct the flow of air and odors to the olfactory epithelium, which causes impairment of the sense of smell.

6. Snoring.

A different value of the air flow velocity through the right and left halves of the nose leads to different pressure on the uvula of the soft palate, causing its hypertrophy, and as a consequence, the vibration of hypertrophied areas during sleep creates a sound phenomenon “snoring”.

7. Headache.

The cause of a headache with a curvature of the nasal septum can be a violation of the flow of oxygen into the blood (hypoxia), which is especially acute during physical and mental stress. And also mechanical irritation of reflexogenic zones by contact of opposite walls of the nose in the presence of thorns, ridges of the nasal septum.

8. Changes in the shape of the nose.

In case of traumatic curvature of the nasal septum – dislocations, fractures of the septum cartilage – the shape of the nose changes.There is a mixing of the nose to the right or to the left, the formation of the hump of the nasal dorsum. Such conditions, as a rule, are combined with fractures of the bones of the nose.

These are the main symptoms that allow one to suspect a curvature of the nasal septum. Symptoms vary depending on the degree of curvature. A slight curvature of the septum that causes no symptoms occurs in many people. In such cases, treatment is usually not required.

Diagnosis: Curvature of the nasal septum, – as a rule, does not cause difficulties and can be established by an otorhinolaryngologist with direct rhinoscopy of the nose.In cases of localization of the curvature in the deep parts of the nose, additional diagnostic methods can be used, such as: video endoscopy of the nasal cavity; X-ray of the paranasal sinuses; computed tomography of the paranasal sinuses.

With a pronounced curvature of the nasal septum, the treatment of this disease is surgical. The name of the operation is septumplasty. The scope of surgical treatment also includes the correction of those changes that caused the presence of curvature of the nasal septum (hypertrophy of the nasal concha mucosa).To eliminate them, submucosal vasotomy (conchotomy) of the lower turbinates is performed simultaneously with septumplasty. The operation is performed in a hospital (ENT department) at the place of residence, in a planned manner: the patient undergoes the necessary examination on an outpatient basis, and then goes to the hospital.

The operation is performed by a qualified ENT surgeon.

Anesthesia during this operation is usually local. The patient is injected with an anesthetic solution into the nasal mucosa.If the patient wishes, the operation can be performed under general anesthesia.

In children, the operation is performed when they reach the age of 14-16, and in case of severe disturbances in nasal breathing – from the age of 6. Anesthesia is only general.

The duration of the operation usually does not exceed 40 minutes. After the operation, special tampons are inserted into the patient’s nasal cavity, which are removed after 24-48 hours. So-called “breathable” tampons are currently used.Small latex or gel swabs with a small tube inside that allows the patient to breathe after surgery.

The patient’s ability to work is restored after 2 weeks. After surgery, the patient should avoid physical activity for a month.

Complications of this operation are rare. These include: nosebleeds, perforation (violation of the integrity) of the nasal septum, synechia (fusion) of the nasal cavity. The latter refers to a postoperative care defect.After the operation and removal of tampons, it is mandatory to carry out a toilet of the nasal cavity at least 1 time a day for a week, which must be carried out by an ENT doctor.

Therefore, after discharge from the hospital, the patient must be observed by an ENT doctor at the place of residence.

Otorhinolaryngologist,

Head of the Department of Extrabudgetary Activities

Republican Scientific and Practical Center of Otorhinolaryngology

Tatiana Nikolaevna Butsenko

Nose injuries | MC Garant

Nose injuries are common.There is hardly a person who has never hit the bridge of his nose in his entire life. And although bruises in the minds of thousands of people are more associated with childhood, when restlessness prevails, and bruises come with new adventures and discoveries, the life of a modern adult is also full of potential dangers.

First of all, the risk group is, of course, fans of extreme sports and outdoor activities. Injury to the bones of the nose is possible with a strong blow, and therefore the environment of numerous falls, careless sharp movements, is a fertile ground for a variety of fractures, dislocations, cracks.However, in everyday life, there is a risk of injury. How to determine the severity of the damage received? What first aid can you provide yourself?

If a nose injury is suspected

Let’s say something happened: you lifted a fork that had fallen under the table and accidentally touched the bridge of your nose on the edge, did not notice the glass door, and fell victim to another popular flying toy while walking in the park.

For initial self-diagnosis, you need to know, first of all, the list of symptoms that can be indicators of various conditions.With a bruise, slight swelling is permissible, a bruise will appear. Bleeding can often be observed, in which it is necessary to remember that throwing your head back is wrong.

What should be done in case of a nose injury?

It is necessary to apply cold to the bridge of the nose, use cotton swabs and tilt your head to your chest. Remember that if the bleeding does not stop for an extended period (10 minutes or more), you need to urgently seek medical help.

Against the background of a somewhat innocent, although, of course, unpleasant picture of a simple bruise, the symptoms of a broken nose look much more dangerous: profuse bleeding, lacrimation (usually the result of a combination of injuries to the orbit / tear ducts and the bridge of the nose itself), as well as leakage of cerebrospinal fluid. Often a fracture of the nose is accompanied by a concussion – it is also important to remember the clinical picture and this condition.

There are a number of guidelines for primary health care.In case of serious injuries, of course, you need to call an ambulance or go to the nearest emergency room. Small bruises and scratches can be treated at home: you need to rinse with clean water, after which something cold should be applied to the bruise. Remember that when using ice or frozen foods (in a domestic environment, this is the first thing that comes to hand), you must wrap them in a clean towel. Avoid direct contact between ice and skin.If there is a bleeding wound on the surface, it is enough to press a tampon soaked in hydrogen peroxide against it and hold it for about five minutes. In the event of an injury to the nasal septum, bleeding is possible: if it is profuse, but there are no signs of a fracture, you can try to stop it with the same tampon soaked in hydrogen peroxide.

If the picture is much more serious

If the situation remains critical (bleeding does not stop, there are signs of a broken nose, concussion), you should seek qualified medical help as soon as possible.Treatment of a nasal injury should be carried out under the supervision of a specialist in order to avoid further complications and to prevent life-threatening and health-threatening situations.

Nose trauma as a cause of snoring

Sometimes, injuries to the nose lead to a deviation of the nasal septum, which in turn causes snoring. You can read the article “Snoring Treatment”

90,000 Curvature of the nasal septum. ENT clinic “Sun”

The nasal septum is a bone-cartilaginous plate that divides the nasal cavity into two approximately equal halves.In the front, it is formed by cartilage, and in the back, by bone. On both sides, the axial septum is covered with a mucous membrane.

The causes of curvature can be trauma, abnormal development of cartilage and bone structures of the facial skeleton, the formation of polyps, hypertrophy (enlargement) of the turbinates, tumors of the nasal structures and other reasons.

Curvature of the nasal septum can be very diverse in shape, the degree of disturbance of nasal breathing. The most common forms of curvature are S-shaped bends, ridges, spines, growths in the nasal septum at the junction of the cartilaginous and bone tissue of the nasal septum.

The main complaint of the patient with this disease is nasal congestion, mucous discharge, sometimes mucopurulent discharge. Some patients report recurrent headaches, dry throat, congestion and tinnitus, and a general decrease in the sense of smell.

Headache with deformation of the nasal septum is due to the fact that the curved part of the nasal septum (crest) is in contact with the opposite side wall of the nose, irritate the mucous membrane, which reflexively causes a headache.The pressure of the bent part of the nasal septum can lead to the development of vasomotor rhinitis and the development of an inflammatory process in the auditory tube and middle ear.

However, sometimes the curvature of the nasal septum does not cause any noticeable sensations in the patient, or disturbances in nasal breathing, or other complaints. Thus, the indications for the treatment of nasal septum curvature, as such, should be based on the patient’s complaints and the clinical manifestations of the curvature.

Diagnostics

Deformation of the nasal septum is easily diagnosed.The diagnosis is made on the basis of the patient’s complaints, history and rhinoscopic picture. A very informative method for finding out the nature and degree of deformation of the nasal septum is the use of an endoscope.

Rhinometry and computed tomography (CT) are also used.

Treatment

Treatment is usually surgical. Among the many types of operations on the nasal septum, there are: classic radical surgery – submucosal resection of the nasal septum and septoplasty – remodeling of the septum with its own cartilage.

Submucosal resection of the nasal septum is performed more often stationary, after a preliminary examination of the patient. In some cases, it is possible to remove curved areas (thorns, ridges) on an outpatient basis.