nasal fracture

by / Saturday, 11 April 2015 / Published in Uncategorized

Projecting prominently from the central part of the face, it is no surprise that the nose is the most commonly broken bone on the head. A broken nose (nasal fracture) can significantly alter your appearance. It can also make it much harder to breathe through the nose.

What is a nasal fracture?

Getting struck on the nose, whether by another person, a door, or the floor is not pleasant. Your nose will hurt—usually a lot. You’ll likely have a nose bleed and soon find it difficult to breathe through your nose. Swelling develops both inside and outside the nose, and you may get dark bruises around your eyes (“black eyes”). Nasal fractures can affect both bone and cartilage. A collection of blood (called a “septal hematoma”) can sometimes form on the nasal septum (a wall made of bone and cartilage inside the nose that separates the sides of the nose).

Causes of a broken nose

• As the nose is the most prominent feature on your face — protruding unprotected— it’s also the facial feature most at risk of injury
• Broken noses account for approximately 40% of all facial fractures
• Your nose is supported by cartilage (in the front) and bone (on the back and bridge) – when this framework of bone and cartilage is struck with a force, the bones can crack or fracture — resulting in a broken nose
• Common causes of a broken nose include:

  1.  Injury from contact sports, such as football, basketball or soccer.
  2.  Fighting, when punches are thrown.
  3.  Motor vehicle accidents.
  4. Falls.
  5. A broken nose can even be caused by activities such as walking into a fixed object or by rough, wrestling-type play.

Complications of a broken nose – other broken nose symptoms

Deviated septum

• A nose fracture may cause a deviated septum, a condition that occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced to one side, narrowing your nasal passage on that side
• Medications can help you manage a deviated septum, though surgery is required to correct the condition
Collection of blood (nasal septal haematoma)
• Sometimes, a collection of blood called a septal hematoma may accompany a nose fracture
• A septal hematoma can block one or both nostrils
• Septal hematoma requires emergency surgical drainage to prevent cartilage damage

Cartilage fracture

• If your fracture is due to a forceful blow, such as from an automobile accident, you may also experience a cartilage fracture
• If your injury is severe enough to warrant surgical treatment, the surgery would address both your bone and cartilage injuries

Neck injury

• Likewise, nose fractures resulting from high-velocity injuries — like those experienced in motor vehicle accidents — may be accompanied by injuries to your neck (cervical spine)
• If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck
• If you suspect a neck injury, see your doctor immediately

When should I see a doctor?

If you’ve been struck in the nose, it’s important to see a physician to check for septal hematoma. Seeing your primary doctor or an Emergency Room physician is usually adequate to determine if you have a septal hematoma or other associated problems from your accident. If a septal hematoma is present, it must be treated promptly to prevent worse problems from developing in the nose. If you suspect your nose may be broken, see an otolaryngologist—head and neck surgeon within one week of the injury. If you are seen within one to two weeks, it may be possible to repair your nose immediately. If you wait longer than two weeks (one week for children) you will likely need to wait several months before your nose can be surgically straightened and fixed. If left untreated, a broken nose can leave you with an undesirable appearance as well as permanent difficulty in trying to breathe.

What you can do before your appointment

• Immediately after your injury, apply ice to the area to help keep swelling down
• Use light pressure to keep the ice on your nose
• Over-the-counter pain relievers, such as paracetamol, can help reduce pain. Ibuprofen can also help relieve inflammation

How will my doctor determine if I have a broken nose?

Your doctor will ask you several questions and will 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. The doctor will examine not only your nose, but also the surrounding areas including your eyes, jaw, and teeth, and will look for bruising, lacerations, and swelling. Sometimes your physician will recommend an x-ray or computed tomography (CT) scan. These can help to 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.

What are my treatment options?

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. You can have your nose repaired in the office in some situations. Your doctor can give you some local anesthesia, reposition the broken bones into place, and then hold them in the right location with a “cast” made of plastic, plaster, or metal. This cast will then stay in place for a 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.

What if I need surgery?

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 have begun to heal. 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 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. Should you be interested in this kind of appearance change as well as repair, you can feel confident that your otolaryngologist is a specialist in all surgery of the nose. No other specialty has more training in surgery on the nose, and some otolaryngologists focus exclusively on plastic surgery of the face.

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