Broken nose

Another problem that can be observed very often in connection with the nose are fractures of all kinds. Because of its exposed, protruding position in the face, the nose is particularly at risk of being injured by trauma. Conceivable here are knocks, blows or even impact trauma after a fall or a fall.

Since the nose consists of about two thirds bone and the rest cartilage, characteristic structures break more often. A distinction is made between open and closed fractures of the nasal bone (Os nasale), both of which are often accompanied by an injury to the nasal septum. The term “open fracture” means that parts of the bone have broken through the skin and are visible on the surface.

Thus, open fractures are unambiguous and usually easily recognizable. In a closed fracture, on the other hand, the skin may be externally completely uninjured or show only a small laceration or bruise. These fractures are then also more difficult and not quite as clearly visible.

Often the diagnosis is only externally, as already mentioned, more difficult to confirm with certainty. Nevertheless, there are some clues to be aware of: If external changes can be noticed, the most noticeable feature is usually an oblique position of the bridge of the nose. In the case of direct force from the front, one often sees a widened, rather flat nose.

It seems to be pushed apart. In almost all cases there are also typical accompanying symptoms such as nosebleeds, a bruise (haematoma) in the affected region, pain (usually pulsating and lasting for a long time) and severe swelling of the nose. All this naturally leads to a deterioration of the air supply with breathing problems and a significantly reduced ability to smell.

The swelling of the surrounding tissue is often the reason why a fracture cannot be assessed with certainty externally. If the patient’s pain does not allow it, it is also possible to try to move the nose a little. In the case of a fracture, the nose is much more mobile overall than an intact nose.If the nasal septum is also injured, there is an increased susceptibility to infections and inflammations in the nasopharynx, frequent nosebleeds and newly occurring snoring.

In many cases, the suspected diagnosis is already clear on the basis of the course of the accident; however, an x-ray of the facial skull is always recommended to confirm this. This also serves to rule out further fractures, for example of the zygomatic bone (see: zygomatic fracture) or in the area of the jaw bone. After this diagnosis, further therapy is then necessary for the patient.

In many cases a conservative therapy is chosen, i.e. treatment without surgical intervention. This is always possible if individual fragments are not or only slightly displaced and can be pressed back into the correct position by the treating physician. The nose is then treated with the help of a plaster cast or splint and should be spared afterwards.

The further healing process usually takes about two weeks. In the case of severely displaced fractures or shattered bone parts, surgical therapy should be chosen. Ideally, the operation should be performed on the day of the accident and aims to restore the original shape and position of the bones.

If the treatment is quick, the chances are generally quite good that the fracture of the nasal bone will heal completely, leave no permanent damage and will not be visible externally after some time. However, if the bones are not straightened (reduced) or if a mistake is made in the process, a so-called saddle nose or crooked nose can result. Rarely does this picture go hand in hand with an impairment of breathing, usually only a cosmetic-aesthetic problem remains.

(see: Nose correction) Normally, the operation is performed through the nostrils with camera support. In the course of the operation a small incision may be necessary on the inner wall of the nose. All fragments are rejoined intra-operatively (during the operation) and brought into their original position. In general, the patient will also need a plaster cast or splint afterwards to allow the nose fracture to heal without consequences.