Diagnosis | Nasal contusion

Diagnosis

Anamnesis (patient interview) is used to clarify the cause of the injury, which can then be clarified in more detail by means of a palpation examination. If a more serious finding is suspected, the injury can be depicted more precisely and narrowed down using imaging techniques. These procedures are usually classical x-rays, computed tomography (X-ray tomography) or magnetic resonance imaging.Since an injury can also be a fracture (bone fracture), it is important to first rule out this finding in order to exclude drastic consequences.

Therefore, a contusion is always a diagnosis of exclusion, which can be safely ruled out by means of the listed procedures. A reliable differentiation can only be made by means of an X-ray image. Here, the radiography shows whether it is a fracture of the nasal bone.

However, a first impression can be gained by means of external inspection before the X-ray is taken. If the nose is crooked, this is already a strong indication of a fracture of the nasal bone. Within the sharp-edged tears in this case, a pronounced regional hematoma may occur, which is caused by injury to surrounding capillaries.

Likewise, due to mechanical interactions of the fracture edges, a rubbing, crunching noise can be heard and felt. If a more serious defect is suspected in structures around the nose, more complex procedures such as computed tomography or magnetic resonance imaging should be used to enable a more accurate assessment. In case of a negative result after exclusion of a bony fracture, the diagnosis of bruising can be made as an exclusionary diagnosis. Magnetic resonance imaging, which is sensitive to soft tissue, can be a further diagnostic step after considering the cost-benefit ratio.

TreatmentTherapy

Both conservative and drug therapies are possible as a diagnosis of exclusion (i.e. after a nasal bone fracture has been reliably excluded). Non-drug therapies include cold applications (e.g. 3x 10 min per day) in the area of the bruise. This makes it possible to limit the inflammation and relieve the pain.

Immobilization, slight compression, as well as holding the body part upright are also possible, but in the area of the nose they can only be implemented to a limited extent. Classic painkillers should be administered at the same time. The drugs indicated here are non-steroidal antirheumatic drugs (also called COX inhibitors), which have an anti-inflammatory effect in addition to their analgesic effect and thus increase the patient’s sense of well-being in both cases.

ASA, Ibuprofen and Diclofenac are to be mentioned here, as well as Paracetamol (separate group of medicines). However, these drugs should be carefully weighed up with each patient on medical advice due to their side effects. The drugs facilitate the healing process, but do not accelerate it. If there is irreparable tissue damage, surgical intervention may be necessary. If an extensive bruise (hematoma) is visible in the area of the contusion, depending on the tissue pressure and size, the removal of the hematoma may be discussed.