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Nasal Fracture

Broken Nose

Nasal fractures, occurring after either intentional or accidental trauma, are fairly common in clinical practice. Displacement of the nasal bone, epistaxis, local ecchymoses, edema, and tenderness are the main clinical features. The diagnosis relies on details obtained during history taking, findings from physical examination, and if necessary, imaging studies.


Presentation

Nasal fractures are one of the most common forms of facial trauma in medical practice, with certain reports suggesting that they comprise up to 40% of all skeletal fractures [1] [2] [3]. They arise from trauma in virtually all cases, the most common form being a blunt trauma during contact sports [1] [4]. In children, sports-related activities are the events leading to fracture, whereas motor vehicle accidents, falls, and intentional injuries, in addition to sports, are common causes in adults [1] [3]. Many reports have confirmed that the peak incidence of nasal fractures is seen in adolescents around 20 years of age and that males suffer from nasal fractures much more frequently than women [4] [5]. Depending on the mode of injury, patients present with a variable appearance of the nasal bone. It may be displaced outwardly after a lateral blow or depressed posteriorly after a direct blow to the nose [1]. In some patients, however, the deformity might not be apparent [1]. In addition to anatomical changes (nasal shortening, widening of the nasal base and malposition are also seen) epistaxis is the prominent symptom, indicating a more pronounced fracture [1] [4] In addition, ecchymoses, local tenderness, edema, and crepitus are frequently noted [1] [2] [4]. In severe fracture, leakage of the cerebrospinal fluid (CSF), termed CSF rhinorrhea, changes in mental state, and limited movement of the eyes might be observed, in which case injuries of other anatomical structures should be excluded [1] [4]. In fact, it is not uncommon for nasal fractures to be accompanied by additional maxillofacial or cervical injuries, especially in severe trauma [1].

Fishing
  • […] idiopathic apical ballooning syndrome, and stress-induced myocardial stunning, has been first described by Japanese authors in 1996 and subsequently specified in 2001; it derives from the resemblance between the ancient round-bottomed, narrow-necked Japanese fishing[ncbi.nlm.nih.gov]
Impaired Balance
  • Common sources of nasal fractures include sports injuries, fighting, falls, and car accidents in the younger age groups, and falls from syncope or impaired balance in the elderly.[en.wikipedia.org]
Internal Bleeding
  • Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.[nlm.nih.gov]
Saddle Nose
  • For nasal fracture presenting saddle nose deformity, the nasal septum was fixed with the frontal process of the maxillary bone by Kirschner wire. Good results were confirmed with computed tomography, and there was no secondary deformity.[ncbi.nlm.nih.gov]
  • Even if the use of an instrument is deemed necessary, such as in treating saddle-nose-type fractures, initially feeling the fracture with the little finger will still allow for a more precise fracture reduction.[ncbi.nlm.nih.gov]
  • Otherwise, there were no complications such as saddle nose, canthal dystopia, canthal webbing, or nasolacrimal outflow obstruction. No patient needed or desired revision rhinoplasty.[ncbi.nlm.nih.gov]
  • Though uncommon, a septal hematoma can lead to complications such as septal abscess, septal perforation and cartilage necrosis with potential saddle nose deformity.[ttsh.com.sg]
  • That in turn can cause severe deformity of the nose such as ‘Saddle Nose’. The other issue to determine is if the nose has become crooked compared to what it looked before the injury.[janjuafacialsurgery.com]
Rhinorrhea
  • This may be caused by cerebrospinal fluid draining from the brain into the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on the nose or ears. Infection of the nose, sinuses, or facial bones.[cigna.com]
  • This may be caused by cerebral spinal fluid draining from the brain into the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on the nose or ears. Infection of the nose, sinuses, or facial bones.[myhealth.alberta.ca]
Nasal Congestion
  • Skip to content Find Out More About Nasal Fracture A broken nose is a traumatizing and painful event that can lead to nasal congestion, a cosmetic problem, or both.[breatheclearinstitute.com]
  • Bleeding Nasal congestion but without any production of any drainage Bruising around the nose and eyes A grating sound with trying to move the nose.[epainassist.com]
  • Nasal congestion. Infection - eg, cellulitis, fever, discharge. Epistaxis. Aetiology Traumatic: Nose-picking. Trauma. Septal haematoma may cause infection and abscess formation ( which may lead to perforation) if not treated promptly.[patient.info]
Nasal Pain
  • Symptoms of nasal injury The patient may present complaining of nasal pain, nasal deformity, difficulty breathing through the nose as well as bleeding from the nose. Some patients may also complain of headache.[entauckland.co.nz]
  • -if a closed nasal fracture requires direct access, Þ elective transverse incision at nasofrontal angle -primary bone grafting can be considered /-screw fixation COMPLICATIONS Septal hematoma -persistent nasal pain and excessive swelling of the septum[ent.com.au]
  • Common symptoms after nasal trauma —Ask about nasal pain, epistaxis, and nasal deformity. 8 Less commonly, the nose can be inflamed and blocked; this could affect a patient’s ability to breathe through his or her nose.[bmj.com]
Snoring
  • Such injuries may result in deformities affecting the outside and inside structures of the nose, which can cause problems breathing, sinus infections, nose bleeds, snoring, nasal obstruction and distorted facial features.[entaacare.com]
Difficulty Opening the Mouth
  • Displacement, difficulty opening the mouth and double vision are associated with some fractures and require treatment.[entaacare.com]
Chest Pain
  • She underwent general anesthesia for the reduction of the fracture; after surgery, she developed acute chest pain, elevated cardiac biomarkers, ischemic electrocardiogram changes, and transient akinesis of the left ventricle without significant epicardial[ncbi.nlm.nih.gov]
Blue Eyes
  • Swollen and black and blue eyes are common. When should I see a doctor for a broken nose? If the nose looks about the same and your breathing is fine then you may not need to see a doctor.[nycfacemd.com]
  • Swollen and black and blue eyes are common. Risk Factors Leading To A Fractured Nose Risk factors leading to a fractured nose are similar to the causes, contact sports, physical fight, motor vehicle accident, or a fall.[nycfacemd.com]
Epistaxis
  • Displacement of the nasal bone, epistaxis, local ecchymoses, edema, and tenderness are the main clinical features. The diagnosis relies on details obtained during history taking, findings from physical examination, and if necessary, imaging studies.[symptoma.com]
  • Pain, bruising, epistaxis (nose bleeds), obstruction, change in shape may or may not be present.[rhinoplasty-blog.com]
  • One of the most frequently used packing materials in closed reduction of a nasal bone fracture is the hydroxylated polyvinyl acetate sponge (PVAS; Merocel( )); however this may cause synechia, epistaxis, and pain.[ncbi.nlm.nih.gov]
  • . • Persistent bleeding through the nose (epistaxis) • Presence of a hole in the nasal septum that divides the nose.[medindia.net]
  • A nosebleed that you cannot stop (epistaxis). Clear drainage from one or both nostrils (CSF rhinorrhea). Treatment, if needed, usually is done within 7 to 14 days of breaking your nose.[cigna.com]
Facial Scar
  • Yet, closed approaches are commonly favored for nasal fractures for simplicity, the avoidance of a facial scar, and because exposure to the nasal bones through traditional approaches is limited.[ncbi.nlm.nih.gov]
Sinus Headache
  • In addition to allergies, ENT specialists treat deviated septum, rhinitis, sinusitis, sinus headaches and migraines, nasal obstruction and surgery, and more. Dr. Spencer C.[entnet.org]
Altered Mental Status
  • The last concern for immediate closure is that the patient may not be able to give proper consent if they were intoxicated or otherwise have altered mental status.[newyorkentspecialist.com]

Workup

The diagnosis of a nasal fracture can be easily made with a proper clinical workup consisting of a detailed patient history and a physical examination. The exact mechanism of injury, including the direction, the intensity and circumstances under which it occurred, should be revealed during history taking, whereas a detailed inspection and palpation of the nose, but also the surrounding structures (the orbit, the mandible, the teeth, zygomatic arches and the cervical spine) are vital steps in recognizing the extent of trauma [1] [2] [4] [6]. If an apparent displacement of the nose is evident during the exam, a definite diagnosis is made solely on clinical criteria, but in the setting of an apparently normal anatomical appearance, imaging studies are necessary to validate clinical suspicion [1] [5] [6]. Plain radiography is considered to be a useful initial method for the detection of nasal fractures, with very high rates of diagnoses [5]. Certain reports, however, have established that ultrasonography (US), particularly high-resolution (HRUS), may be a superior method compared to X-rays in this particular setting [6] [7] [8]. Computed tomography (CT), a definite imaging procedure that can confirm the exact site of the fracture, but also identify additional head injuries, is not widely used due to its high radiation dose and exposure to the lens and the thyroid gland [1] [6] [7]. Despite the important role of imaging studies in the evaluation of nasal fractures, clinical awareness is pivotal in making an early diagnosis [1] [7].

Ischemic Changes

Treatment

  • We therefore consider our method to be both safe and effective at the initial stage of diagnosis and for the treatment of patients presenting with nasal bone fractures.[ncbi.nlm.nih.gov]
  • […] of an uncomplicated fracture of nasal bones is not urgent—a referral for specific treatment in five to seven days usually suffices—an associated injury, nasal septal hematoma, occurs in about 5% of cases and does require urgent treatment and should be[en.wikipedia.org]
  • Preferred Name Open treatment of nasal fracture; with concomitant open treatment of fractured septum Synonyms Open reduction of fracture of nasal bone with open repair of fracture of nasal septum ID altLabel Open reduction of fracture of nasal bone with[bioportal.bioontology.org]
  • How long is the recovery after treatment for a nasal fracture? Patients who have closed nasal reduction have some swelling and discomfort for 5-7 days after treatment. It is important to avoid heavy activity during the recovery.[syracuseoto.com]
  • Dallas patients seek treatment from Dr. Bassichis after receiving treatment from their primary care doctor. During the consultation, Dr.[advancedfacialplastic.com]

Prognosis

  • Plain radiograph sensitivity 80% 6 best detected on the lateral view Waters view is useful in assessing the nasal arch 4 CT sensitivity is 100% 6 Treatment and prognosis Treatment depends on the degree of displacement.[radiopaedia.org]
  • Prognosis In most cases, the outlook is good, even when surgical treatment is necessary to realign or reconstruct the nose.[drugs.com]
  • Lateral-type injuries, which are more common, tend to have less severe damage and a better prognosis than the frontal types. 27, 33 Stranc and Robertson 33 developed a classification system using these two main groups, with further breakdown of the frontal[clinicalgate.com]

Etiology

  • Less common causes include falls and motor vehicle accidents. [7, 8] In a retrospective study, Erdmann et al investigated the medical records of 437 patients with 929 facial fractures. [3] These authors noted that the most common etiology of facial trauma[emedicine.medscape.com]
  • A retrospective analysis of facial fracture etiologies. Ann Plast Surg . 2008 Apr. 60(4):398-403. [Medline] . Cantrill SV. Facial trauma. Rosen P, ed. Emergency Medicine: Concepts in Clinical Practice . 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.[emedicine.medscape.com]
  • A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008 Apr. 60(4):398-403. [Medline]. Cantrill SV. Facial trauma. Rosen P, ed. Emergency Medicine: Concepts in Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.[emedicine.medscape.com]
  • Due to the variations in individual anatomy and trauma etiology, there are several different types of nasal injuries that may be encountered.[clinicalgate.com]

Epidemiology

  • Detailed knowledge of the epidemiology and diagnostic and therapeutic methods becomes imperative for the effectiveness of patient care.[scielo.br]
  • Epidemiology of US high school sports-related fractures, 2005-2009. Clin J Sport Med . 2010 Jul. 20(4):293-9. [Medline] . Hanba C, Svider PF, Chen FS, Carron MA, Folbe AJ, Eloy JA, et al. Race and Sex Differences in Adult Facial Fracture Risk.[emedicine.medscape.com]
  • Epidemiology of US high school sports-related fractures, 2005-2009. Clin J Sport Med. 2010 Jul. 20(4):293-9. [Medline]. Hanba C, Svider PF, Chen FS, Carron MA, Folbe AJ, Eloy JA, et al. Race and Sex Differences in Adult Facial Fracture Risk.[emedicine.medscape.com]
  • EPIDEMIOLOGY -of maxillofacial fractures, nasal fractures constituted 39%. - males in favor by 2 to 1 and higher incidence 15- to 30-year age group PATHOGENESIS -nasoethmoidal complex has a maximum tolerable impact force before fracture of 35 to 80g.[ent.com.au]
  • Is there a change in the epidemiology of nasal fractures in females in the UK? J Laryngol Otol 2013 ; 127 : 1084 -7. Joshi H, McPartlin D. Management of nasal fractures in a rural district general hospital: a completed loop.[bmj.com]
Sex distribution
Age distribution

Pathophysiology

  • In addition to an overall review of maxillofacial trauma pathophysiology, associated injuries, and physical examination, this review will also discuss relevant imaging, treatment, and disposition plans.[ncbi.nlm.nih.gov]
  • Pathophysiology: 1. Nasal bones and underlying cartilage are susceptible for fracture because of their more prominent and central position in the face. 2. These structures are also pretty brittle and poorly withstands force of impact. 3.[drtbalu.co.in]

Prevention

  • With this method, the occurrence of unnecessary new fractures can be prevented, in addition to minimizing the degree of mucosal damage and the occurrence of nasal hemorrhage.[ncbi.nlm.nih.gov]
  • Prevention You can help prevent a nose fracture with these guidelines: Wear your seat belt when traveling in a motorized vehicle, and keep children restrained in age-appropriate child safety seats.[mayoclinic.org]
  • To prevent more severe consequences of a nasal fracture, it’s important to seek immediate medical assistance from a primary care physician or the emergency room.[advancedfacialplastic.com]
  • You should also avoid taking aspirin generally if you are under the age of 20 to prevent Reye syndrome.[suncoastentsurgery.com]
  • Prevention A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray and water soluble jelly (such as Ayr gel) can help prevent nosebleeds, especially during the winter months.[tampaent.com]

References

Article

  1. Kucik CJ, Clenney T, Phelan J. Management of acute nasal fractures. Am Fam Physician. 2004;70(7):1315-1320.
  2. Pérez-Guisado J. Clinical Evaluation of the Nose: A Cheap and Effective Tool for the Nasal Fracture Diagnosis. Eplasty. 2012;12:e3.
  3. Reilly MJ, Davison SP. Open vs closed approach to the nasal pyramid for fracture reduction. Arch Facial Plast Surg. 2007;9(2):82-86.
  4. Kelley BP, Downey CR, Stal S. Evaluation and Reduction of Nasal Trauma. Semin Plast Surg. 2010;24(4):339-347.
  5. Çil Y, Kahraman E. An analysis of 45 patients with pure nasal fractures. Ulus Travma Acil Cerrahi Derg. 2013;19(2):152-156.
  6. Javadrashid R, Khatoonabad M, Shams N, Esmaeili F, Jabbari Khamnei H. Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures. Dentomaxillofac Radiol. 2011;40(8):486-491.
  7. Mohammadi A, Ghasemi-Rad M. Nasal bone fracture--ultrasonography or computed tomography? Med Ultrason. 2011;13(4):292-295.
  8. Gürkov R, Clevert D, Krause E. Sonography versus plain x-rays in diagnosis of nasal fractures. Am J Rhinol. 2008;22:613–616.

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Last updated: 2018-06-22 10:54