Complications of Nasal Septal Fracture: An Insight

Introduction

Facial injuries commonly result in nasal bone and septum fractures, impacting appearance and breathing due to the nose's prominent location and delicate structure. Skin, bone, and cartilage comprise the nose's support structure, and the nasal septum is essential to preserving stability and functionality. Healthcare teams must work together during treatment to guarantee the best results for the affected patients. The goal of the diagnosis and therapy is to address functional and cosmetic issues while restoring the structure and function of the nose.

What Are the Causes of Nasal Septal Fracture?

Numerous injuries to the maxillofacial skeleton can lead to nasal bone fractures.

Worldwide, the following are common causes of nasal bone fractures:

• Violence between people.

• Motor vehicle accidents.

• Athletic mishaps.

• Falls.

Traffic accidents cause nasal bone fractures more frequently in North America than interpersonal violence. Depending on the area, sports-related or auto-related accidents are the main causes of injuries in youngsters. Compared to fighting-related sports, ball-related sports like rugby, baseball, basketball, and soccer have a higher rate of nasal bone fractures.

How Common Are the Nasal Septal Fractures?

• Males are more likely than females to suffer from nasal bone and septal fractures, which is associated with a higher incidence of interpersonal violence in men.

• The second and third decades of life are the most common times for nasal bone fractures.

• Since 2000, the number of nasal bone and other facial fractures has increased in the US, while the number of surgical repairs has remained constant. This pattern can point to a move toward conservative treatment methods, nonoperative management, and a greater reliance on computed tomography (CT) imaging to guide care.

How to Examine a Patient With Nasal Septal Fracture?

Following maxillofacial trauma, patients receive a thorough history and physical examination, as well as a primary trauma survey that focuses on airway, breathing, circulation, and impairment. It is important to comprehend the trauma mechanism, particularly in high-energy collisions like car accidents that might result in many facial fractures. The impact direction must be considered while evaluating fracture patterns because lateral strikes can result in particular fracture patterns.

Evaluation of premorbid appearance and post-injury breathing alterations facilitates the diagnosis of intranasal edema or damage to the septum. A thorough physical examination of the head, neck, and nasal passageways is essential for identifying abnormalities such as septal deviations or nasal fractures. Any indications of CSF leaking, septal hemorrhage, or nasoorbitoethmoid fractures need to be thoroughly evaluated and treated right away.

How to Diagnose Nasal Septal Fractures?

Imaging Suggestions:

• Most simple fractures of the nose bone heal without imaging.

• For the most part, plain film X-rays are useless in diagnosing nasal bone fractures.

• When assessing bony trauma in the maxillofacial region, a CT (computed tomography) scan without intravenous contrast of the facial bones is seen as the best option, especially if there are concerns about more severe injuries.

Imaging Indications:

• Imaging tests should be ordered for additional evaluation in response to symptoms that cause concern.

• Even with new research, ultrasonography is still not as good as CT scanning for identifying nasal bone fractures.

Laboratory Evaluation:

• For simple nasal bone fractures or septal hematomas, routine laboratory testing is usually not indicated.

• However, patients with substantial epistaxis or anticoagulant medication may benefit from coagulation testing and a full blood count.

• For patients with continuous, unrestricted rhinorrhea, a beta-2-transferrin analysis of collected fluid can be used to confirm or exclude the possibility of a cerebrospinal fluid (CSF) leak.

What Are the Treatment Options for Nasal Septal Fractures?

The fracture's degree and accompanying symptoms determine the course of treatment for a nasal septal fracture. The following are typical methods of treating nasal septal fractures:

First Aid and Epistaxis Management:

• Start by sealing any external or internal nasal lacerations and managing epistaxis when possible.

• Digital pressure is a conservative method of managing epistaxis; in more severe situations, cauterization of nasal packing may be necessary.

Observation and Conservative Measures:

• Individuals who do not have a noticeable nasal blockage or cosmetic abnormality can be monitored immediately without surgery.

• Conservative measures, such as head elevation and cold packs, are advised to lessen edema. After the edema has subsided, a careful follow-up is advised to check for nasal deviation again within three to five days.

Closed Reduction:

• Closed reduction may be tried when nasal septal fractures result in nasal deviation or obstruction.

• Closed reduction involves manually realigning the misplaced septal fragments using a Boies or Sayre elevator. Either local or general anesthesia can be used for this.

Open Reduction (Septoplasty):

• This procedure may be required in cases where closed reduction fails or when complicated septal fractures involving mucosal disturbances occur.

• A septoplasty is required to access the nasal septum, realign shattered portions, and restore normal nasal architecture.

• Open septorhinoplasty is usually not recommended in an acute situation because it can cause nasal lacerations or disturbances of cartilage.

• Three to six months after the accident, delayed septorhinoplasty is advised to reduce the risk of infection or problems with the cartilage graft.

Nasal Packing or Splinting:

• Nasal packing or splinting may be utilized after closed or open septal fracture reduction to stabilize the septum and stop future displacement.

• Additionally, nasal packing can promote the repair of the nasal tissues and assist in stopping bleeding.

Postoperative Care:

• Instructions on pain management, nasal cleanliness, and follow-up appointments should be given to patients receiving treatment for septal fractures.

• While recovering, it is usually advised to avoid activities that could aggravate nasal damage or strain the septum.

What Are the Complications of Nasal Septal Fracture?

Nasal septal fracture complications can differ depending on the extent of the fracture and any accompanying injuries.

Typical issues include:

• Nasal Deformity: Visible nasal deformities, such as deviation or collapse of the nasal bridge, can result from nasal septal fractures and may impact one's appearance.

• Nasal Obstruction: Breathing through the affected nostril might be challenging if nasal obstruction is caused by the nasal septum becoming dislodged due to a fracture.

• Epistaxis, or Nosebleeds: Blood vessel damage from nasal septum fractures can induce nosebleeds, which can occur repeatedly or persistently.

• Septal Hematoma: After trauma, blood may build up within the nasal septum (septal hematoma), which, if left untreated, can result in elevated pressure and possibly infection.

• Septal Perforation: Nasal crusting, a prolonged nasal discharge, and whistling noises when breathing can all be symptoms of a serious nasal septal fracture resulting in a septum perforation (hole).

• Chronic Sinusitis: Nasal septal fractures, which can interfere with regular sinus outflow, increase the risk of chronic sinus infections (sinusitis).

• Cosmetic and Functional Impairment: Insufficient treatment for a septal fracture can result in long-term cosmetic and functional impairment, which can leave a persistent nose deformity or obstruction.

• Secondary Infections: Broken nasal bones and damage to the septum might raise the possibility of developing secondary infections, such as osteomyelitis (bone infection) or sinusitis.

• Chronic Nasal Congestion: Untreated or poorly managed septal fractures may lead to prolonged nasal edema or the production of scar tissue.

• Psychological Impact: A significant nose deformity or functional impairment brought on by a fractured septum may adversely affect one's quality of life and self-esteem.

Conclusion

For nasal septal fractures, it is critical to get a medical evaluation and the right care to reduce complications and maximize results. Based on each patient's needs, ENT or face trauma specialists can determine the extent of the injury and suggest appropriate treatment choices. Nasal septal fractures can have long-term consequences that can be avoided with prompt and effective treatment.