A fractured nose is the most common facial fracture. It usually results from blunt injury and is commonly associated with other facial fractures. The severity of the fracture depends on the direction, force, and type of the blow. A severe comminuted fracture may cause extreme swelling or bleeding that may jeopardize the airwayand require a tracheotomy during early treatment.
Fractures of the nasal bones usually result from direct trauma. The causative injury can be relatively minor such as a fall, or more severe such as a motor vehicleaccident.
Nasal fractures can cause septal deviation and bone displacement, resulting in an airway obstruction. These complications can be permanent if treatment is inadequate or delayed. The patient may also develop septal hematoma, leading to abscess formation and avascular and septic necrosis. Other possible complications include cerebrospinal fluid (CSF) leakage and intracranial air penetration, which may lead to meningitis.
The patient’s history reveals a direct blow to the nose. He usually reports the immediate onset of pain, a nosebleed (ranging from minimal trickling to hemorrhage),and soft-tissue swelling. If his nasal passages are obstructed, he may breathe noisily.If you perform inspection soon after the injury, you may note a swollen nose with bleeding and deformity or displacement of the nose from the midline. A fracture maynot be obvious, however, because swelling can obscure the break.Inspection performed several hours after the injury may reveal periorbital ecchymoses (raccoon’s eyes), nasal displacement, and deformity.You may be able to identify the fracture on palpation.
X-rays help to confirm the diagnosis and determine the extent of injury.
The patient may not need treatment unless he has suffered bone displacement, septal deviation, or a cosmetic deformity.When necessary, prompt treatment restores normal facial appearance and reestablishes bilateral nasal passages after swelling subsides. Reduction of the fracture(restoring the displaced bone fragments to their normal positions) corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose andtaped) maintains it. Nasal fractures should be reduced within the first 24 hours if possible, using local anesthesia for an adult and general anesthesia for a child. Severe swelling may delay treatment for several days to per week, making reduction more difficult. In this case, the patient may need general anesthesia.If CSF leakage occurs, the patient needs close observation and antibiotic therapy. Septal hematoma requires incision and drainage to prevent necrosis.