Nasal Fractures (Broken Nose)
Fracture of the nose is the most common type of facial fracture. The nose contains the most frequently broken bones in the face. In addition to fracture of the nasal bones, cartilage of the nose is frequently injured which can significantly contribute to breathing problems and change of the shape of the nose. As a result of traumatic nasal injuries, the rich network of blood vessel around and within the nose leads to immediate nasal bleeding and bruising around the eyes. The nose and eyes may appear swollen and a change in nasal shape may become apparent. The bruising and swelling always resolve with time but the underlying injuries of the bone and cartilage framework will not.
A Broken Nose May Lead to Nasal Obstruction
Many factors contribute to nasal blockage after nose trauma. First, the inside lining of the nose will be swollen effectively narrowing the nasal passages. Commonly, displacement of the nasal septum worsens nasal blockage and contributes to permanent reduction of nasal airflow. This nasal septum forms the inside division between the two sides of the nose. Cartilage and bone form the supportive structures of the septum. Displacement and fracture of the nasal septum lead to obstruction of nasal breathing.
Fracture of Nasal Bones Defines Classic “Broken Nose”
The nasal bones form the upper one third of the nose. These bones are relatively thin plates. This fragility on concert with the prominent position of the nose within the facial profile explain, why the nose is commonly fractured as a result of a blow to the nose. An X-Ray can show this fracture although plain nasal X-Rays are notorious for their inaccuracy. In fact, most nasal surgeons do not require a nasal X-Ray as it rarely impacts treatment decisions.
Open and Closed Nasal Fractures
A broken nose is considered “open” if a laceration of the overlying skin exposes the underlying nasal bones. Technically, tears of the inside lining of the nose also lead to open nasal fractures. Most likely, this is more commonly the case than not. Usually, this has only little impact on the management except that skin lacerations need to be repaired. The presence of an open or closed fracture is much more significant in injuries of the extremities; therefore, orthopedists worry significantly about open fractures of arms or legs.
Nasal Skin Laceration with the Broken Nose
If the overlying nasal skin is injured, treatment may become necessary. The skin is usually simply sutured as soon as possible if a full thickness laceration is present. This will limit risks for infections. Commonly, skin abrasions are present. These abrasions can appear quite dramatic initially but they may heal very well with the help of correct wound care. The depth of abrasion is the main deciding factor whether a scar will result. The acute trauma is usually not the time for fancy plastic reconstructive maneuvers as these injuries often heal up very well. If improvement is desired, this is best delayed until healing is complete.
Exclude Important Additional Injuries with a Broken Nose!
After any nasal trauma, more severe injuries of the face and body need to be excluded. For instance, a loss of consciousness after the trauma need to be further assessed. Also, other facial bones may be fractured and need surgical realignment. Commonly, all facial fractures including the nasal fracture are treated at the same time. Therefore, a thorough clinical assessment is important.
Initial Nasal Examination after Nasal Fracture is Important
Every fractured nose should be assessed by a physician familiar with treatment of nasal injuries. Bleeding can be substantial and may not stop spontaneously. Nasal bleeding can also reoccur, sometimes even days after the initial injury. Nasal examination should be performed of both the outside and the inside of the nose. Sometimes, blood collection underneath the lining of the nasal septum (a.k.a. septal hematoma) need to be identified and treated quickly.
Surgical Repair of a Nasal Fracture is the Gold Standard
Noses that result in significant deformity and obstructed breathing should be considered for surgical repair. In most cases, this repair is still somewhat elective. People could live relatively healthy lives after an untreated isolated nasal fracture. Nasal obstruction could lead to obstructive sleep apnea und may impact the overall quality of life. But nasal surgery likely would provide the best chances for a good outcome.
Early Surgery for the Broken Nose
If the injury if fresh and the underlying bones are still mobile, an attempt can be made to “reset” the nose. Outcome after this “closed reduction” of a nasal fracture may range from minimal improvement to almost optimal realignment. Important is a timely treatment, usually within the first week. It may be good to wait a few days to allow reduction of the initial swelling.
Delayed Surgery for Nasal Fracture Repair (Rhinoplasty)
If the nose has healed into an unsatisfactory position after nasal fracture, “open” treatment may be the only option. This surgery needs to address breathing and nasal appearance alike which makes it very similar to cosmetic rhinoplasty for a congenital deformity. Often, the bones and cartilages have to be realigned, support of the nose has to be improved or reestablished, a new nasal bump needs to be shaved and the nose needs to be narrowed. The nasal breathing is maximized by straightening of the nasal septum. Sometimes, the nasal turbinates need improvement and strengthening of the nasal sidewall can further improve breathing.
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