Nasal bone fracture, nasal fracture
Diagnosis
If there is a change in the shape of the nose, there is no longer any doubt about a nasal bone fracture. Otherwise, the diagnosis is made on the basis of an X-ray. This also records the exact location of the fracture gap and shows any shifts in the individual bone fragments.
To be able to assess non-bony structures, such as the nasal septum, an inspection of the inside of the nose (technical term: rhinoscopy) is necessary. Careful palpation of the nose can be used to detect broken edges of bone or to determine the mobility of individual bone fragments. If there is a suspicion of concomitant injuries in the area of the orbit, the base of the skull or other bones, a computed tomography (CT) or magnetic resonance imaging (MRI) should be performed in addition to the X-rays.
In the case of a nasal bone fracture, a basic distinction must be made between open and closed fractures. Since bone fragments pierce the skin surface in the presence of an open nasal bone fracture, this type of fracture is usually quite easy to detect. A closed nasal bone fracture, on the other hand, is much more difficult to detect.
In the case of a closed nasal bone fracture, a clear deformation of the nasal skeleton is not always visible. In most cases, the fracture only becomes apparent as it progresses and is therefore often more difficult to detect. Nevertheless, the appearance of typical symptoms may indicate a fracture of the nasal bone and make it easier to recognize the fracture.
Typical symptoms of a fracture of the nasal skeleton are bleeding from the nose and swelling of the tissue surrounding the nose. Patients affected by a fracture of the nasal bone usually complain of severe pain in the midface area. These pains often take on a pulsating character and persist over a longer period of time.
In addition, the pain characteristic of a fractured nasal bone can be made worse by a light touch or feel. In most cases, this pain symptomatology also significantly limits speech and the use of the facial muscles. Furthermore, the presence of a fracture of the nasal bone can often be recognized by visible abrasions and/or lacerations in the area of the nose.
Bruises (haematomas) can be observed in the affected patients both directly on the nose and in the area of the zygomatic bones and/or the eye sockets. As a rule, the violent force exerted on the nasal bone causes significant swelling of the interior of the nose. For this reason, the fracture of the nasal bone can often be recognized by a restriction in nasal breathing.
In addition, the sense of smell is often negatively affected by damage to the nasal skeleton. Visually, the presence of a nasal bone fracture can be recognized in many of the affected patients by a clear malposition of the nasal skeleton. In this context, a lateral deviation of the bridge of the nose from one of the two halves of the face is usually the most common.
The occurrence of a visibly depressed nasal bridge is also not uncommon with a nasal bone fracture. Furthermore, a fracture of the nose can classically be recognized by the fact that the entire nose or the nasal skeleton is much more mobile. Due to the rather descriptive symptoms, the fracture of the nasal bone can be detected relatively quickly and reliably in everyday clinical practice (gaze diagnosis).
Especially the visible deformation and the formation of bone steps help the physician to recognize the nasal bone fracture as such. Nevertheless, a radiographic examination should definitely be arranged. Only in this way can the extent of the nasal bone fracture be estimated and further fractures excluded.
The treatment of the nasal bone fracture is divided into surgical and non-surgical (conservative) measures. The choice of the appropriate form of treatment depends on the condition of the bony structures and the extent of the soft tissue injuries. If the individual fracture fragments are not or only slightly displaced, it is usually sufficient to treat the nasal bone fracture with a plaster cast or splint.
After about two weeks, the stability of the bony nose is restored to such an extent that the treatment is considered complete. However, if the nasal bone fracture is unstable and/or severely displaced, treatment must be carried out by surgical reduction. Surgical correction of the nasal bone should ideally take place within one day of the accident.
The aim of the treatment is to restore the original position of the nasal bone and subsequently keep the bone fragments stable.The surgical treatment of a fractured nose can be performed under local or general anesthesia. As a rule, the individual fragments are brought into their original position starting from the inside of the nose (access through the nostrils). In the majority of patients, however, it is necessary to make a small additional incision on the inside of the nose.
In this way, comminuted fractures in which several small pieces of bone are present can be easily repositioned and fixed. Since it is possible that parts of the nasal septum are also destroyed in a fracture of the nasal bone, more extensive surgical treatment may be necessary. To stabilize the nasal septum, small plastic foils are usually inserted into the nose and fixed there.
Bruises can also be removed during the treatment. This measure offers the advantage of reducing the risk of In addition, it can be observed in everyday clinical practice that the cartilage structures of the nose require a plaster cast or splint to be applied after the nasal bone fracture has been cleared. To avoid bleeding in the area of the incisions, a nasal tamponade can also be inserted into both nostrils.
This tamponade is usually removed on the first day after the operation.
- Tissue necroses
- Inflammatory processes and
- Infections
A fracture of the nasal bone can in many cases be treated without surgery (conservative therapy). However, if the nasal bone fracture is particularly unstable and if there are displaced fragments, surgery is usually necessary.
Only surgical treatment can restore the normal position of the bone fragments and stabilize the nasal skeleton. In principle, surgery to treat a nasal bone fracture can be performed under local anesthesia. However, in many cases the reconstructions to be performed are so extensive that a nasal bone fracture surgery under general anesthesia is preferred.
A blood sample should be taken before the surgical procedure is performed. This measure serves to check the patient’s blood coagulation ability and to determine whether an intraoperative transfusion might be necessary due to blood loss. After the preparatory measures have been taken, an explanatory consultation with the responsible anesthesiologist is carried out.
General anesthesia is initiated immediately before the nasal bone fracture surgery. In the case of surgical treatment of the bony nose, ordinary ventilation by intubation via the oral cavity can be performed. During surgery, the individual bone fragments are brought back into their proper position through small surgical incisions inside the nose and the natural shape of the nose is restored.
Normally, no scars are visible even after a nasal bone fracture surgery. In some cases, however, an additional incision must be made below the bridge of the nose. This procedure allows the skin covering the nose to be folded back, thus providing a better view of the nasal skeleton to be operated on.
If the nasal septum is broken in addition to the bony nasal framework, it must be straightened. This is usually done by inserting and fixing two flexible plastic foils. Incorrect straightening of the nasal septum can, under certain circumstances, lead to severe restrictions in nasal breathing and make further surgery necessary.
If an additional bruise (hematoma) has formed, it must be removed. Otherwise, the hematoma can lead to tissue loss and the development of inflammatory processes. The result is a significant limitation of wound healing and an extension of the healing time.
After the nasal bone fracture surgery, the bone fragments must be stabilized with a plaster cast or a special splint. In addition, a tamponade is usually inserted into the nose for at least one night. Often, the fracture of the nasal bone results in the impairment of surrounding structures.
If this is the case, measures must be taken beyond the normal course of a nasal bone fracture surgery. The occurrence of intraoperative complications (e.g. bleeding) may also make it necessary to extend the usual surgical technique. Within the first week after surgery, there is usually severe swelling in the area of the surgical site.
However, these can be quickly brought under control by careful cooling. Complications may occur during the nasal bone fracture surgery.Among the most frequent complications are injuries to the smallest nerve fibers, which can lead to limited sensitivity. In most cases, however, the affected nerves recover within a period of a few months.
Cutting through larger nerve fibers can lead to paralysis and cause the feeling of temperature changes. In addition, there is a risk of infection and inflammatory processes in the area of the surgical site after a nasal fracture operation. The surgical incisions made during a nasal bone fracture surgery are usually treated with self-dissolving sutures.
For this reason it is not necessary to remove the sutures. The self-dissolving sutures dissolve completely within a period of approximately six months. Especially during many contact and ball sports, accidents associated with a fracture of the nasal bone occur time and again.
Some athletes (especially in soccer) suffer a nasal bone fracture several times during their career. This can not only lead to medical problems, but also have aesthetic consequences. In addition to the risk of narrowing the nostrils and the resulting obstruction of the airway, the nose is often deformed after a multiple fracture of the nasal bone.
These may have to be corrected by a plastic surgeon. In order to protect the nasal bone from strong forces during sports, a so-called nasal mask can be used. Particularly in the period immediately following surgical treatment of a fractured nasal bone, the bony nose must be protected at all costs.
Wearing a mask in the case of a nasal bone fracture is therefore particularly useful during this time. Such a mask is individually adapted to the face of the respective athlete. For this purpose, a plaster cast of the nose and cheek region must be made.
Based on this plaster cast, a suitable mask for nasal bone fracture can then be made. The fabrication of a mask after nasal fracture is possible in most orthopedic specialty stores. The cost of such a protective mask varies depending on the material chosen.
The particularly stable carbon masks are usually the most expensive. However, cheaper versions are also offered. On average, the price of a mask after a nasal fracture is between 100 and 500 euros. In most cases, the costs of a mask for nasal bone fracture are not covered by the statutory and private health insurance companies, as it is not a medically necessary measure. For this reason, the patient is usually forced to bear the resulting costs himself.
