Nasal Injuries

February 8, 2013

Nasal injuries can occur in the context of violence, motor vehicle injuries, sports injuries and falls. There can be blunt trauma, lacerations, avulsions and fractures as a result of these injuries. Some of these injuries can lead to surgical intervention. Secondary revision surgery or autogenous grafts may be necessary. It may take a multidisciplinary surgical team to manage the injury. The nasal bone may need to be reconstructed and avulsions may need to be grafted if not enough skin is covering the wound.

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Nasal fractures are the most common facial fractures one will see. They are often not recognized and aren't treated at the time of the injury. Because the nose sticks out and because it is in the middle of the face, it is predisposed to being injured when the face is injured. Most nasal fractures tend to involve the nasal septum, which is a problem when it comes to a successful reduction of the fracture.

Fractures can be open or closed, depending on whether or not the mucosa is broken open. It is important to identify whether or not the fracture is open because infection can occur in open fractures and need antibiotics. Doctors need to determine if there is a septal hematoma and evacuate the hematoma if present. Failure to do that can cause erosion of the hematoma into the septal bone. Infections can happen with nasal septal hematomas.

Nasal fractures are the third most common of the various fractures one can get. The first and second most common fractures are clavicle fractures and wrist fractures. Other common facial fractures are zygomatic arch fractures at 22 percent, blowout fractures at 12 percent, mandibular bone at 8 percent and maxillary bone at 9 percent of facial injuries. A study of more than 200 patients showed that fractures of the nasal bone were the most common fracture sustained in sports injuries. Nasal septal injuries are on the rise now that airbag use is on the rise.

In kids, nasal fractures are most commonly because of falls. One must always consider the possibility of child abuse in all children who present with a nasal bone fracture. The major clinical findings in adults and children of a nasal bone fracture are a change in the nasal appearance, bleeding from the nose (especially if the mucosa has been disrupted), infraorbital bruising and a change in nasal appearance.

If the nasal fracture has severely abnormal nasal function, an abnormal appearance and the presence of early post injury complications, there is a possible need for surgery. There are a lot of different ways to do internal and external reduction and fixation so the nose looks and behaves normally.

For example, closed reduction can be done under local anesthesia with or without mild sedation, especially if the nasal bone fracture is simple or there is a combination simple nasal bone and septal fracture.

If there is open reduction, there needs to be general anesthesia. This should happen whenever there is extensive fraction-dislocation of the nasal bone and septum, fracture dislocations of the caudal septum or in cases of open septal fractures.

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