Definition
A contusion in the nasal region is the result of a blunt direct impact on bony, cartilaginous tissue, skin and mucous membrane. The damaged tissue in the case of nasal contusion is connective tissue and fatty tissue. The physical impact rarely results in a defect of the skin, but only of the mentioned underlying layers. The contusion must be clearly distinguished from a fracture, as this results in different needs for action. A nasal contusion is thus an exclusion diagnosis, since the exclusion of a nasal bone fracture results in a nasal contusion.
Causes
Blunt external violence can usually be traced back to a deliberate or unforeseeable event. The most common cause of a nasal contusion is a traffic accident, falls of any kind, sports accidents (e.g. martial arts) or the use of force by third parties. It is important to note that only a direct impact on the tissue leads to a contusion.
Associated symptoms
The typical signs of inflammation are particularly noteworthy in the case of a contusion. This is a painful swelling, which can appear overheated and reddened due to excessive blood circulation in the nasal region. The consequence of this is a functional impairment due to the swelling, which means that nasal breathing can only be painful.
In addition to the signs of inflammation, nosebleeds (epistaxis) and/or a hematoma may occur as a result of vascular or capillary injuries. Experience has shown that nosebleeds return after a short time. The swelling that makes breathing through the nose difficult, as well as the pain can force the patient to breathe through the mouth.
As a result, painful breathing can lead to respiratory protection, which in rare cases can lead to pneumonia if certain areas of the lungs are not ventilated. Depending on the cause of the injury, headaches can accompany the injury. The symptoms of a contusion overlap strongly with those of a fracture.
Therefore, a clear diagnosis should always be made by a physician if possible. Headaches associated with a contusion can have different causes. In particular, the nose is a source of pain.
Headaches caused purely by soft tissue defects of the nose can be called rhinogenic headaches. However, there can also be a transmitted pain (referred pain) in the area of the face and nose, which can then lead to perceived headache. This means that the pain experience is created by joining sensitive nerve cords in the nose with the cords of other regions of the head that are actually responsible for the headache.
Orthopedic causes are also to be mentioned as a source, which have arisen in the company of the external force and must then be further clarified. The symptom of the outflow of blood from the nose, called epistaxis in the clinic, is a common side effect of the nasal contusion. It is typical that the epistaxis subsides after a short time.
The reason for this is the good blood supply of the nasal mucosa, especially in the area of the locus Kiesselbachi, which is located in the anterior lower third of the nasal mucosa. In the event of violent impact, the smallest vessels can thus be injured and cause blood to leak. If haemostasis does not occur, therapeutic measures such as tamponade or obliteration of the blood vessel are necessary.
The inflammatory sign of swelling is caused by tissue mediators (tissue-active substances). The reaction is part of the healing process, but is usually experienced as unpleasant to painful. The swelling is characterized by increased blood flow, so that tissue can be repaired with the help of flooded blood components.
Since it is a benign space-occupying process, softer or missing facial contours are visible in the area of the nose. In principle, the increased tissue pressure is not harmful. However, care should be taken to ensure that other nearby tissue is not squeezed or squeezed.
