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Nasal Fractures - Causes, Symptoms, Diagnosis, and Treatment

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Nasal Fractures - Causes, Symptoms, Diagnosis, and Treatment

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A nasal fracture is a break or fracture of a bone in the nose; the more commonly affected site is the bridge of the nose.

Medically reviewed by

Dr. Akshay. B. K.

Published At August 8, 2022
Reviewed AtJanuary 22, 2024

Introduction

A nasal fracture is the most common fracture of the face. There is a break in the bone or cartilage of the nose, either the bones that form the bridge of the nose or in the sidewall or the septum of the nose (the structure that divides the nostril into two). The common cause of this is contact sports, motor vehicle accidents, physical fights, and falls which will result in trauma to the face.

Nose injuries are commonly tagged along with neck injuries. A trauma that can cause nose injury will definitely result in injury to the neck too. Nasal injuries can sometimes be life-threatening, as in the case of a fracture to the cartilage of the nose, which results in a pooling of blood in the nose. In this case, if drainage is not attained early, it can lead to abscess formation or permanent deformity, which can block the nose and can be dangerous. When the nasal fracture causes a deformed nose, the surgical correction can be done within the first two weeks of the injury.

What Causes a Nasal Fracture?

The common causes of nasal fracture are:

  • Trauma from contact sports such as boxing, football, and hockey.

  • Physical fight.

  • When the face hits the floor or other surfaces after a fall.

  • Motor vehicle accidents.

  • In trauma involving mouth or teeth, one should suspect a nasal fracture.

What Are the Symptoms of a Nasal Fracture?

The symptoms of the nasal fracture include the following:

  • Bleeding from the nose (epistaxis).

  • Pain or tenderness.

  • Displaced bone or cartilage of the nose.

  • Change in shape of the nose.

  • A dip in the nasal bridge.

  • Bruising around the eyes and the nose.

  • Swelling is seen on the nose and the surrounding areas.

  • Difficulty in breathing.

  • Discharge of mucus from the nose.

How to Diagnose Nasal Fracture?

The diagnosis is made by the doctor by doing a physical examination. The doctor will gently palpate the nose and look for any fracture. Also will look inside the nose to look for any blockage inside or visible fracture. As the patient may have pain, the doctor will use local anesthetics in the form of sprays for doing the palpation. The doctor may also advise an X-ray or CT scan so as to get a clear picture of the involvement and extent of the fracture, as other facial bone fractures can also be suspected. Also, in case of severe injury, the radiography method will aid in diagnosis as doing a physical examination might not be feasible.

What Are the Treatment Options?

If the fracture is minor and does not cause any disfigurement to the structure of the nose, then the doctor would advise some medications for the pain and other self-care methods like applying ice over the site of injury.

When a nose injury happens, the following first aid should be done:

  • Calm the patient.

  • The patient should be seated in an upright position so that the blood is not aspirated.

  • Ask the patient to breathe through the nose.

  • Hold the nostrils closed and apply pressure so as to stop the bleeding.

  • Apply cold compression for the swelling around the nose.

  • Take over-the-counter painkillers like Acetaminophen.

The doctor might realign the fracture segment manually or surgically. If there is a fracture in the nasal bones, the doctor will be able to manually fixate them if you consult the doctor within the first two weeks of the injury. In order to do manual realignment, the doctor would give anesthetics to that area either in the form of spray or injections. Uses special instruments to fix the fracture without any opening made in the skin. Following this, a nasal pack is given, and maybe a dressing will be given from outside. This pack is given for at least one week. Also, the doctor will prescribe antibiotics so as to prevent any infections.

In other cases, the fracture needs to be fixed surgically, such as in severe fractures, multiple fractures, or fractures left untreated for more than 14 days. If there is a fracture to the nasal septum that causes obstruction or difficulty in breathing, then reconstructive surgery might be done.

When to See a Doctor?

Medical attention should be given right away when you notice any of these things, such as:

  • When you suspect head or neck injury along with nasal injury.

  • Nasal bleeds, which you cannot stop.

  • Clear fluid drainage from the nose.

  • Vomiting or a patient being unconscious following a trauma.

  • When you suspect a blood clot in the nasal septum.

  • When there is difficulty in breathing through the nose.

  • When there is a noticeable deformity to the shape of the nose.

What Are the Complications of Nasal Fracture?

The complications related to the nasal fracture are:

  • Deviated Nasal Septum - Upon injury to the nasal septum, the nasal septum, which divides the nostril into two sections, may get deviated from the midline to any side, causing the narrowing of the nasal passage, which will interfere with breathing. Nasal decongestants and antihistamines can be given for temporary relief from the symptoms, but surgery can only be the solution for this condition.

  • Pooling of Blood- Sometimes, following a nasal trauma, the pooling of blood happens in the nasal septum, which is known as a septal hematoma. This hematoma can block one or both nostrils. Pooling of blood is a serious complication and requires immediate surgical drainage.

Conclusion

A nasal fracture is a break in the bone or cartilage of the nose which can occur while playing a contact sport, falling, in physical fights, or in motor vehicle accidents. A minor fracture requires only self-care and over-the-counter painkillers, but in severe fracture, surgical intervention will be required. If you suspect any injury to the nose following an accident, consult a doctor as early as possible because with early intervention, minimal treatment will only be required. Minor fractures can be aligned manually by a doctor only if the patient reports to the doctor within the first 14 days of the injury. Always keep in mind to use safety equipment while playing a contact sport or driving a vehicle so that one can prevent such injuries.

Frequently Asked Questions

1.

What Are the Different Types of Nasal Bone Fractures?

Nasal bone fracture is classified as follows:
- Type 1 - Simple and unilateral nasal bone fracture.
- Type 2 - Simple and bilateral.
- Type 3- Comminuted.
- Type 4 - Complex (nasal & septal disruption),
- Type 5 - Associated with midface fracture and NEO fracture.

2.

Is Nasal Bone Fracture a Serious Complication?

Nasal bone fractures cause pain, swelling, and bruising around the nose and under the eyes. The nose may look crooked, and people may have trouble breathing through it. Surgery is not required for all fractures.

3.

How Long Does a Nasal Bone Fracture Take to Heal?

A nasal bone fracture usually does not require any treatment and can heal on its own within three weeks. But emergency medical attention is necessary when a nose injury is accompanied by a head or neck injury.

4.

Does Nasal Fracture Require Emergency Attention?

Usually, nasal fractures are untreated because some patients do not seek treatment. But some patients with nasal fractures are more likely to present to urgent care settings or emergency treatment. Fractures with substantial edema or fracture involving the head and neck need immediate attention.

5.

What Is the Treatment for Nasal Fractures?

- For minor fractures, an ice pack and over-the-counter painkillers will be helpful.
- For displaced bones and cartilage, the health care provider may manually realign them. This should be done within 14 days of fracture.
- Reconstruction surgery is required for severe and multiple breaks to realign the bones and reshape the nose.

6.

How Should We Sleep With a Nasal Fracture?

The healthcare provider might suggest sleeping with the head elevated, which aids in pain and reduces swelling. In addition, the health care providers might hold off on other treatments until the swelling subsides to assess the need for realignment.

7.

What Happens if the Nasal Fracture Is Left Untreated?

If nasal fractures are left untreated, it can lead to long-term cosmetic problems and breathing problems due to nasal obstruction and collapse.

8.

Does Nasal Bone Fracture Go Unnoticed?

Yes, often mild nose fractures go unnoticed by the doctor and patient, as the injury causes only mild swelling and a brief nosebleed. As a result, many people will be unaware of the break unless the nose heals with a slight deformity.

9.

Is Surgery Required for Nasal Fractures?

Multiple breaks, severe breaks, or breaks that have been left untreated for more than 14 days mostly require reconstructive surgical intervention. If needed, surgery will realign and reshape the nose.

10.

What Happens After a Nasal Bone Fracture?

After a nasal bone fracture, it causes pain and a nosebleed. Patients may also experience swelling and bruising around their noses and under their eyes. The nose may also look crooked, and they may have trouble.

11.

What Is the Best Drug for Nasal Fracture?

For nasal fractures, take over-the-counter medicine for nasal decongestants, and to reduce pain, take medication like acetaminophen or ibuprofen.

12.

Whether Are Antibiotics Required for Nasal Bone Fracture?

If any fracture communicates with open skin wounds, it should always be provided with prophylactic antibiotics.

13.

What Antibiotics Are Given for Open Nasal Bone Fracture?

For open nasal fractures, antibiotics to cover gram-positive organisms will be required. In addition, cephalosporins such as cefuroxime or cefazolin can be given. And for severe fractures with soft tissue contamination, gram-negative antibiotics should also be administered.
Source Article IclonSourcesSource Article Arrow
Dr. Akshay. B. K.
Dr. Akshay. B. K.

Otolaryngology (E.N.T)

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