NASAL BONE FRACTURE
Fracture of the nose is the commonest fracture in humans.
Epidemiology:
More common in Caucasians than Asians or Africans.
Aetiology:
Usually low velocity trauma to the nose is the common cause. This may result from:
- Personal assault.
- Sports injuries.
- Road traffic accidents.
- Personal accidents.
Types of fracture:
Class I: Blow of severity due to frontal or fronto-lateral trauma. There is a breach in the quadrilateral cartilage with depression or displacement of distal part of nasal bone.
Class II: Medium velocity lateral trauma. There is a breach in root of nasal bone and maxillary process of frontal bone. The ethmoid labyrinth is intact.
Class III: High velocity trauma. Fracture extends to the ethmoid labyrinth. The patient has pig like appearance. Injury to lacrimal sac and nasolacrimal duct may be present. Clinical features:
Class II: Medium velocity lateral trauma. There is a breach in root of nasal bone and maxillary process of frontal bone. The ethmoid labyrinth is intact.
Class III: High velocity trauma. Fracture extends to the ethmoid labyrinth. The patient has pig like appearance. Injury to lacrimal sac and nasolacrimal duct may be present. Clinical features:
- Swelling of nose.
- Periorbital ecchymosis.
- Tenderness.
- Nasal deformity: Depressed from the front or side, or whole of the nasal pyramid deviated to one side.
- Crepitus and mobility of fractured fragments.
- Epistaxis.
- Nasal obstruction due to septal injury or hematoma.
- Lacerations of the nasal skin with exposure of nasal bones and cartilage may be seen in compound fractures.
Investigations:
1) Diagnosis of displaced fractures usually can be made on physical examination as X-rays may or may not show fracture.
2) 3D CT scan Face should be done for accurate extent of the fracture, displacement and injuries to the adjacent bones like maxilla and orbit,
2) 3D CT scan Face should be done for accurate extent of the fracture, displacement and injuries to the adjacent bones like maxilla and orbit,
Management:
Treatment:
i. Patient is first managed conservatively with
- Decongestant nasal drops.
- Analgesic and anti-inflammatory medications.
- Steroids.
- Pinching the nose.
- Intravenous tranexamic acid.
- Anterior nasal packing.
- If required posterior nasal packing.
- If bleeding still not controlled cauterize bleeding vessel under direct vision.
- Type I fracture is treated by closed reduction, followed by medical treatment.
- Type II fracture is treated by open reduction, followed by correction of septal deformities.
- Type III fracture is treated by open reduction with sling and it is followed by Septorhinoplasty after 3 weeks.
- Deviated nasal septum.
- Saddling of the nose.
- Bleeding.
- Cerebrospinal fluid leak.
- Orbital complications.
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