broken nose

Nasal bone fracture: description

The nose fracture is one of the most common head and neck injuries. This is because for a nose fracture already a smaller force is sufficient than for the fracture of other facial bones. More than half of all facial fractures are nasal fractures.

The framework of the nose is bony in the area of ​​the nose root. The bone consists of the two nasal bones (Os nasale) and the two plate bone protrusions of the upper jawbone (process frontal of the Maxilla). They form the anterior nasal opening, which is supplemented by the cartilage. The paired triangular cartilage plate (lateral process) forms the lateral nasal wall, the bridge of the nose and turns in the middle into the nasal septum. The two nasal cartilages form the nostrils.

The anatomy of the nose is slightly different in children than in adults. In the offspring, the bones of the nose are shorter and the cartilaginous part is larger. The embedding in a larger soft tissue protects the nose additionally. In the nasal skeleton, there are various growth zones that can be disturbed in a nasal bone fracture, the development of the nose.

Nasal bone fracture: symptoms

Swelling around the nasal bone (such as a fall or a knock on the nose) may break the nose. Symptoms such as a dislocated nasal skeleton and its abnormal mobility confirm the suspicion of a fracture. Sometimes, in the eyes, there is a widespread bleeding under the conjunctiva (hyposphagma). As the mucous membranes are almost always injured in a nasal bone fracture, nose bleeding often occurs directly 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 a blunt frontal or lateral force on the nose. A blow to the anterior part of the nose results in a rupture of the nasal septum. The bony nasal bone and nasal septum may shift, or the nasal septum may detach from the bony groove at the bottom of the nasal cavity.

A broken nose results from a greater amount of trauma. In addition to the nasal bone, the fracture frequently also includes the two flat bony prominences of the upper jawbone, and sometimes also the two teardrops. The nasal septum is usually broken as well. Consequently, a saddle nose or, in the event of lateral trauma, a bony crooked nose may arise.

Nasal bone fracture: examinations and diagnosis

If you suspect a fractured nose, you should consult an ear, nose and throat doctor. The doctor will first ask you about the accident and your medical history. Possible questions could be:

• Did you fall on your nose or was there a direct force on your nose?
• What does the exact accident happen?
• Are you still breathing air through your nose?
• Do you have pain?

The doctor then performs a clinical examination. He inspects the nose and makes a so-called nose (rhinoscopy), in which the inside of the nose can be examined. It can be determined whether the nasal septum has a bruise, is shifted or whether the mucous membranes are torn or bleed. In addition, the doctor can see if bone lamellae sprout. The nosepiece is then carefully scanned by the doctor for bone edges and steps. Careful touching can be a crunch to hear and feel.

Nasal bone fracture: Apparative diagnostics

In order to confirm the diagnosis of nasal bone fracture, x-rays of the paranasal sinuses and nose are taken laterally. In the area of ​​the nasal pyramid, the frontal processes and the leading edge of the nasal septum, fracture lines can be represented. A computed tomography (CT) scan is only necessary if further injuries are suspected in the area of ​​the midface (such as the orbital floor, the orbital border and the ethmoidal cell system).

In children and pregnant women, for whom an X-ray examination should be avoided, the nasal pyramid and the nasal bone can be visualized by ultrasound instead. However, only the bone contours can be visualized, but not the deeper structures such as the maxillary sinus and ethmoidal cells.

Nasal bone fracture: treatment

A nasal bone fracture should not be underestimated, as the nose can permanently deform after the accident and also cause functional damage. At the scene of the accident, an immediate attempt should be made to stop heavy bleeding. The other treatment depends on whether there is a closed, open and / or shifted nasal bone fracture:

Closed nose fracture

With a closed nose fracture you should first take decongestant measures, for example, carefully cool the nose with cold compresses or ice packs. To relieve the pain, analgesics like acetaminophen can be taken. The attending physician will give you closer recommendations. These conservative treatments are usually sufficient for a closed nasal bone fracture.

Open nose fracture

In an open nasal bone fracture, the bone fragments point outward through the skin or into the inside of the nose. Extreme soft tissue injuries to the outer skin can also make bone structures visible. An open nose fracture should be surgically treated as soon as possible. The soft tissues must be supplied, the bone fragments aligned and the wound cleaned. This is important so that the bone does not become inflamed (osteomyelitis).

Moved nasal bone fracture

With each nasal bone fracture postponed, the bone fragments should be reoriented after the soft tissue swells have shrunk, but within the first five to six days after the accident. This is done under general or local anesthesia. Then an attempt is made to anatomically restore the area of ​​the nasal dorsum or the nasal pyramid.

The bone fragments are finally stabilized from the inside with a tamponade and from the outside by a nasal plaster. About three to five days after surgery, the tamponade can be removed again. The cast is changed on the fifth to seventh day, as it relaxes by the swelling of the nose. Thereafter, the plaster is worn for about another week. The plaster serves to maximize the nose and should have a good fit. Aluminum rails are usually not enough.

Nasal bone fracture: Disease course and prognosis

After a broken nose, it takes about six weeks for the bone to become stable again. The patient should avoid exercise and strenuous physical activity during this time, so that the bone fragments do not shift again. Professional athletes can have a special nose-bone mask made, which must be worn after the plaster removal, so as not to risk re-trauma.

Nasal bone fracture: complications

A broken nose can cause a number of complications:

Bruising in the nasal septum is a dreaded complication. In the area of ​​the cartilaginous nasal septum, it bleeds, which means that the cartilage can no longer be nourished. By the pressure of the bruise and the lack of nutrition the cartilage can die off. He can become infected over time, so that untreated, a saddle nose can arise or the nasal septum gets a hole. A bruise of the nasal septum should therefore be operated immediately.

Strong bleeding can occur with every injury and thus with the nasal bone fracture. This is especially true for patients who take blood-thinning drugs such as phenprocoumone or for a long time acetylsalicylic acid. If a source of bleeding appears during the examination, it can be sown under local anesthesia. Thereafter, a nasal tamponade is introduced on both sides.

beyond, there is one broken nose always the risk that the shape of the cartilaginous and / or bony nasal framework changes permanently, so that, for example, a crooked or saddle nose arises.