Treatment of nasal bone fracture
Primarily in the treatment of nasal bone fractures it is of course most important to treat the external wounds of the nose and its surroundings. If the nosebleed does not stop bleeding on its own, it is necessary to insert a nasal tamponade to stop the bleeding. If the nasal bone fractures are not displaced, no therapy is usually necessary, since the individual parts of the nasal bone grow together again correctly even without treatment.
However, if one or more bone fragments have been displaced, it is essential that they be reduced so that no obstruction to nasal breathing remains and a permanent change in the shape of the nose can be prevented. For this reason, therapy by reduction should also be carried out within 8 to 10 days, otherwise it is possible that bones have grown together firmly in the wrong position. Among the shape defects that can remain as a result of not being reduced in time are the so-called saddle nose (where there is a depression on the bridge of the nose) and the crooked nose.
The therapy is performed either under local anesthesia or general anesthesia in the form of intubation anesthesia. During this procedure, the bone elements are lifted from inside the nose with the help of an elevator (a lifting instrument) and brought back into their correct position. Afterwards, the nose is usually fixed with a plaster splint, sometimes with a metal splint, to ensure healing without complications.
In some cases, a nasal tamponade is also used after the procedure to directly stop bleeding (nasal bone fracture). If a septal hematoma or a pronounced septal fracture with a shift is present, surgical therapy must be performed in any case, since especially bends of the nasal septum can cause relatively serious consequential damage. The corresponding procedure is called septoplasty and is characterized by careful straightening of the cartilage structures in the nasal septum.
After the operation, the nose must be splinted from the inside, which is usually done with the help of two plastic plates called “splints”, which are sutured to the nasal septum from both sides to stabilize it. These must remain in the nose for about 5 to 7 days and are then removed by the doctor (nasal bone fracture). In children, therapy for a fractured nasal bone involves basically the same steps as for adults.
To diagnose whether a nasal bone fracture is actually present, various clinical tests can be carried out. A broken nose can usually be moved strongly by pressure with the fingers. Furthermore, affected children complain of severe pain.
In addition, a fractured nasal bone is particularly noticeable in children because of sometimes heavy bleeding from the nose. After a conversation between the treating physician and the parents and a subsequent clinical examination, x-rays are usually taken at various levels. In addition, an ophthalmological examination should be carried out urgently.
In the case of nasal bone fractures, it is not uncommon for the walls of the orbit to be additionally broken. There is also a risk of injury to the eye. Due to the high radiation exposure, computer tomography (abbreviated: CT) is usually not performed on children.
The actual treatment of nasal bone fractures in children is divided into conservative and surgical measures. Immediately after the accident, heavy bleeding from the nose must usually be stopped first. Especially in children, the nosebleed can take on an enormous extent and must therefore be stopped as quickly as possible.
Cold pads, which are applied to the neck and forehead, are particularly suitable for this purpose. The child should sit as upright as possible during hemostasis and tilt the head back slightly. In the case of heavy bleeding, tamponades can be inserted into the nostrils as well.
In the case of a fracture of the nasal bone with no or only minimally displaced fragments, no surgical intervention is necessary, even in children. This type of nasal bone fracture is usually treated by applying a support bandage. However, in the case of unstable and/or severely displaced nasal bone fractures, the therapy must be carried out by surgical reduction.
The aim of the operation is to normalize the position of the nasal bone in children as well and to keep it stable afterwards.A surgical correction of the nasal bone in children should be performed within one day after the accident. Surgical treatment of the fracture of the nasal bone in children can theoretically be performed under local or general anesthesia. However, general anesthesia is usually used for small children in everyday clinical practice.
During the operation, the attending physician attempts to position the bone pieces, starting from the inside of the nose, in such a way that a natural nose shape is created. In many cases, however, it is necessary to make a small incision on the inside of the nose. In this way, especially comminuted fractures (there are many small pieces of bone) can be ideally repositioned.
A fracture of the nasal bone in children with additional involvement of the nasal septum also requires the insertion of two fixing plastic foils. Bruises can also be removed during the surgical procedure. In this way, the risk of tissue necrosis (tissue dies off) and inflammation of the cartilage can be reduced.
A plaster cast or splint must be applied immediately after the operation for a fractured nose bone in children. To avoid heavy bleeding, a nasal tamponade can also be inserted into the nostrils. In cases where the structures surrounding the nose are injured, additional measures must usually be taken.
After surgical treatment of a fractured nasal bone in children, severe swelling and/or bleeding can occur, especially in the first few days. If there is increased nosebleeding, a doctor should be consulted urgently. Swelling can be easily controlled by careful cooling.
In addition, temporary sensory impairment in the area of the nose may occur. In most cases, however, these disappear again after a few weeks. If children complain of pain after conservative or surgical nasal bone fracture therapy, light painkillers such as paracetamol or ibuprofen can be offered.
These preparations can be taken every five to six hours, depending on the children’s weight. In general and especially after an operation, children should not take aspirin. In addition, after surgical nasal bone fracture therapy, children should also be careful not to blow their nose in the first week.
Children should also open their mouths wide when sneezing. An increase in pressure inside the nose can negatively influence the treatment result and/or lead to postoperative bleeding. In addition, care should be taken to ensure that no external pressure is exerted on the straightened nose.
Affected children have to take care not to hit their nose while playing. The result of the repositioning attempt can only be assessed weeks to months after the fracture of the nasal bone in children. The reason for this is that swellings in the area of the nose can remain for a very long time until complete regression occurs.
In addition, it must be noted that this result changes over the years due to the fact that children are still growing. If necessary, corrective surgery may become necessary after a few years. The face masks for nasal fractures can be used so that after the treatment the fracture and the wound heal well and are protected from further irritation.
Normally, the masks are used by professional athletes after a fracture of the nasal bone. The masks are made in specialized orthopedic shops. To make such masks, an orthopedic surgeon must first take an impression of the nose and cheek areas.
The impression is made of plaster and the nose area is the most important part of the impression. A foil is usually placed over the eyes for eye protection. Then plaster plates are carefully placed on the face and pressed on.
To ensure the oxygen supply of the patient, a small hole is usually slit at mouth height. Once the plaster has hardened, the mask has to be adjusted and shaped in detail. With different instruments the mask is rasped and contours and edges are smoothed.
Places that require special protection receive an additional layer of plaster. The masks are usually made of plastic or carbon. Basketball players usually use transparent plastic, whereas handball players and footballers prefer carbon.The carbon provides slightly better protection in case of a head impact, which is especially important for these sports.
Now the next step begins, which is called “deep drawing”. The first step is to drill holes in the eye area. The mask is then coated with silicone grease.
A sheet of malleable plastic is heated to about 150 degrees. When the plate has reached this temperature, the plastic plate must be placed over the plaster model so that it can assume its shape. There is also a vacuum suction cup which is inserted through the drill holes and pulls the plastic plate over the plaster model.
In a final step, the mask only has to be cut out and the patient tries it on last. The fabrication of a mask takes at least eight hours and includes five working steps. However, such custom-made masks are usually very expensive and are not covered by health insurance companies.
They are usually worn and paid for by professional athletes. In addition, face masks are also available in special medical supply stores for about 70 euros, but they are only available in standard sizes and are not custom-made for the respective face. The use of a face mask in case of a broken nose is usually not necessary for non-athletes.
For athletes, the mask is only worn so that one does not have to wait for the complete healing of the fracture and the wound, but can continue with the sport and still be protected from new fractures and injuries. The costs of therapy in the case of a fractured nose bone are usually fully covered by both statutory and private health insurance companies. If the original aesthetic appearance of the face could not be restored even after the standard treatment measures for a nasal bone fracture, some health insurance companies will cover additional cosmetic surgery as a gesture of goodwill.
However, this is not the rule and there is no obligation for the insurance companies to cover the costs incurred. If the cause of the fracture of the nasal bone falls within the coverage areas of a regular accident insurance company, the latter is obliged to cover the costs incurred. However, a broken nose bone that occurs in the course of a brawl is excluded from this regulation in most cases.
In the case of a nasal bone fracture caused by a brawl through no fault of one’s own, the payment of compensation for pain and suffering can be claimed in court. The assumption of the treatment costs by the offender is usually not enforced even in court. At least the usual costs of treatment in these cases are borne by the statutory or private health insurance companies. A subsequent aesthetic operation, however, usually has to be paid for by the affected person himself.
