Nasal bone fracture: Description
Nasal bone fracture (nasal bone fracture) is one of the most common injuries in the head and neck region. More than half of all facial fractures are nasal fractures. This is because a lesser amount of force is sufficient for this than for fractures of other facial bones.
Anatomy of the nose
The framework of the nose is bony in the region of the root of the nose. The bone consists of the two nasal bones (ossa nasalia) and the two flat bony prominences of the maxillary bone (processus frontales of the maxilla). They form the anterior nasal opening, which is completed by the cartilage. The paired triangular cartilaginous plate (cartilago nasi lateralis) forms the lateral nasal wall, the bridge of the nose and bends in the middle into the nasal septum. The two nasal cartilages form the nostrils.
Nasal bone fracture: symptoms
If there is swelling around the nasal bone (such as after a fall or blow to the nose), the nose may be fractured. Symptoms such as a displaced nasal framework and its abnormal mobility raise the suspicion of a fracture. Sometimes, an areal hemorrhage under the conjunctiva (hyposphagma) is also observed in the eyes. Since a fracture of the nasal bone almost always also injures the mucous membranes, nasal bleeding often occurs immediately after the trauma, but this stops after a few minutes. The nose is later blocked by the resulting swelling and bleeding.
Nasal bone fracture: Cause
The cause of a nasal bone fracture is usually blunt frontal or lateral force to the nose.
A nasal bone fracture results from a major force. In addition to the nasal bone, the fracture often includes the two flat bony prominences of the maxillary bone and sometimes also the two lacrimal bones. The nasal septum is usually fractured as well. As a result, a saddle nose or, in the case of lateral force, a bony crooked nose can develop.
Nasal bone fracture: examinations and diagnosis
If you suspect a nasal bone fracture, you should consult an ear, nose and throat specialist. The doctor will first ask you exactly how the accident happened and about your medical history (medical history). Possible questions are:
- Did you fall on your nose or was there direct force to your nose?
- What is the exact course of the accident?
- Are you still getting air through your nose?
- Do you feel any pain?
The doctor also examines the inside of the nose by means of rhinoscopy. This allows him to determine whether the nasal septum has a hematoma, is displaced or whether the mucous membranes are torn or bleeding. In addition, the doctor can see whether bone lamellae are sprouting.
Nasal bone fracture: Apparative diagnostics
X-rays of the paranasal sinuses and the side of the nose can confirm the diagnosis of nasal bone fracture. Fracture lines in the area of the nasal pyramid, the frontal processes and the leading edge of the nasal septum are visible in the X-ray. A computed tomography (CT) scan is only necessary if the physician suspects other injuries in the midface area (such as the orbital floor, orbital rim, and ethmoid cell system).
Nasal bone fracture: treatment
A fracture of the nasal bone should not be underestimated, as the nose can become permanently deformed after the accident and also suffer functional damage. The correct and earliest possible treatment is therefore important. At the scene of the accident, an immediate attempt should first be made to stop severe nosebleeds. Other treatment depends on whether a closed, open and/or displaced nasal bone fracture is present:
Closed nasal bone fracture.
For a closed nasal bone fracture, you should first take decongestant measures, such as gently cooling the nose with cold compresses or ice packs. To relieve pain, the patient can take painkillers such as paracetamol. The attending physician will provide more detailed recommendations on this.
These conservative treatment measures are usually sufficient for a closed nasal bone fracture.
Open nasal bone fracture
Displaced nasal bone fracture
In any displaced nasal bone fracture, the bone fragments should be realigned after the soft tissue has subsided, but within the first five to six days after the accident. This is done under general or local anesthesia. The bone fragments are finally stabilized internally with a tamponade and externally with a nasal cast.
About three to five days after the operation, the tamponade can be removed. The plaster cast is changed on the fifth to seventh day, as it loosens as the nose swells. After that, the cast is worn for about another week. It is used to splint the nose to the maximum and should have a good fit. Aluminum splints are usually not sufficient for this purpose.
Nasal bone fracture: course of the disease and prognosis
Nasal bone fracture: complications
A number of complications can occur with a nasal bone fracture:
A hematoma in the nasal septum is a feared complication. It bleeds into the area of the cartilaginous nasal septum, preventing the cartilage from being nourished. The pressure of the bruise and lack of nutrition can cause the cartilage to die. It can become infected over time, so if left untreated, a saddle nose can develop or the nasal septum can develop a hole. Therefore, a hematoma of the nasal septum should be operated on immediately.
Severe bleeding can occur with any injury and thus also with a nasal fracture. This is especially true for patients who take blood-thinning medications such as phenprocoumon (Marcumar or Falithrom) or acetylsalicylic acid over a long period of time. If the examination reveals a source of bleeding, the physician can obliterate it under local anesthesia. He then inserts a nasal tamponade on both sides.
