Among numerous facial injuries , a nose fracture is considered the most common. Such an injury provokes a violation of the olfactory and respiratory systems. Most often, this condition occurs in everyday life: when falling on slippery ice, on the floor, during a fight. But there are people who are at risk because of their professional activities - athletes and motorists. To restore the state of the organ and correct the bones, the reposition procedure is used.
The structure of the nasal cavity
To determine exactly what a fracture is and how to fix a broken nose, it is important to know its structure. This organ in the upper region borders the skull, in the lower with the mouth, and on the side with the orbits. And the structure of its cartilage and bones is the following scheme:
- The outer wall, which is also called the lateral, includes the nasal and palatine bones, the nasal surface of the upper jaw, the ethmoid bone, the frontal process, the pterygoid processes of the main bone and the lacrimal bone.
- The side walls are connected by a special partition.
- The posterior upper part consists of the opener and the perpendicular plate of the ethmoid bone.
- In the front lower part there is a quadrangular cartilage and a movable part of the septum.
- The upper wall includes a trellis plate, which is easily deformed at the moment of injury.
- In the lateral part of the nose there are large and small wing cartilage.
In most cases, doctors face trauma to the external bones of the nose. Very rarely, damage occurs on the walls of the orbits, the vomer, the nasal concha and the frontal processes. You can fix a nose fracture only in the near future after receiving an injury.
The main symptoms of a broken nose
All nasal cartilages are quite easily injured, as they are fragile. The first symptoms of a fracture will directly depend on the type of damage, as well as on what circumstances and how it was received.
A common sign of a fracture is bone damage and a pronounced displacement of the nasal bridge. If the injury is not severe, then external signs of bone damage are not visible. In this case, the presence of a fracture can be detected only by X-ray examination or computed tomography. And if it came only to the cartilage, then the integrity of the bones can remain in good condition.
If characteristic crisp sounds are heard during palpation of the nose, this indicates the exact presence of damage. But in this condition, the patient is forbidden to independently strongly press on the nose, feel it and carry out any mechanical actions with it, in order to determine the friction of one bone against another. Such a procedure can only be carried out by the attending physician, otherwise the patient will only worsen his condition and provoke complications.
The main signs of injury include the appearance of edema in the area of the nose and eyes, the formation of bruises at the site of the impact, and bleeding. When you click on the damaged area, the patient feels a pronounced pain syndrome, he has difficulty in nasal breathing, there is a desire to blow his nose. Bloody streaks may appear in the eyeballs. In some cases, the patient has a fever.
What types of fractures do they have?
Doctors divide all fractures into the following forms:
- closed - visible violations are expressed to a minimum extent (swelling and minor abrasions can be noted);
- the open form is manifested by wounds on the skin, in which fragments of bones can be viewed;
- a fracture with subsequent bone displacement - in this condition, the shape of the nose changes, becomes asymmetric (can occur against the background of external damage to the skin or have a closed shape);
- deformation of the nasal septum - the nose will sink inward.
It is important to know all the signs and symptoms of a fracture so that you can see a doctor on time to diagnose and start effective treatment. In particular, a timely visit to a specialist is required if the child is injured, since in the future his nose may not form properly, provoking organ curvature, problems with respiratory activity and ENT disease.
In addition to the first symptoms that appear on the first day after receiving a fracture, the patient, as already mentioned, may experience a rise in body temperature. On the third day after injury, infection of the wound with harmful bacteria may occur.
Diagnostics
Before adjusting the nose, doctors use the following diagnostic methods:
- Through rhinoscopy, places of rupture of soft tissue are detected.
- To understand whether there is a displacement of bones and cartilage, the patient is given an x-ray of the side of the nose.
- Inspect internal damage with an endoscope.
- After this, the patient is prescribed a urine and blood test.
After carrying out diagnostic measures, the doctor draws up a treatment regimen. Typically, it looks like this:
- First aid is provided in the form of applying a cold compress to the injured area, which helps to get rid of puffiness and relieve pain.
- With severe pain, the patient is given sedatives and painkillers.
- Inoculate tetanus.
- If a bone shift occurred during the fracture or fragments appeared in them, then a reposition is appointed.
Features of the reposition
To straighten your nose, you can use reposition. The procedure should be carried out in a limited time - from the moment of injury to the reduction of the septum should take no more than 21 days. The optimal time for surgery varies from 5 hours to one week. It is during this period that it is important to seek the help of a doctor.
How to adjust the nose after a fracture? If the patient came to the doctor immediately after receiving an injury, but he has severe swelling of the nose and adjacent tissues, then the resection is transferred for several days until the condition of the soft tissues improves. But after the tenth day of the fracture, the reduction is much more difficult, as bone marrow begins to form on the affected area. In this case, the treating specialist will have to carry out the procedure using a special dressing.
Is it possible to straighten the nose after 3 weeks after receiving the fracture? No, reposition is not allowed. In this case, surgery is delayed for six months, during which the bone is completely fused.
In order to get rid of the wrong accretion, it will be necessary to carry out a complex operation under general anesthesia. The specialist again breaks the bone in the place of improper adhesion and puts it in the correct natural position.
To adjust the nasal septum, the specialist in each case will use a specific method. It will depend on this how quickly and comfortably the treatment itself will take place.
When is reposition used?
Reposition is prescribed for the following varieties of nose fracture:
- With retraction of the nasal bridge - rhinolordosis.
- If the nose bone is too much set inward and outwardly looks too short or wide. Such a fracture is called platirinia.
- If the nose is shifted to the side - rhinoscoliosis.
- With the formation of a hump on the nose after a fracture, rhinocyphosis.
Treatment
If the patient was prescribed a reposition of nasal bones, then all therapeutic measures will be divided into several stages:
- Preparation for surgery, in which the patient will undergo procedures to relieve pain shock and eliminate swelling in the affected area, as well as in the sinuses and strokes. To get rid of bleeding, a tamponade is performed.
- It is painful to straighten your nose only if you do not inject anesthesia. Therefore, the site is anesthetized. It is carried out by introducing anesthesia with a syringe or by lubricating the fracture site with a special drug with an analgesic effect.
- Reposition is carried out manually or using elevators. If there are no elevators, then tweezers are used instead, the ends of which are wrapped with a cloth, and a rubber pipe is put on top. The elevator is inserted into the nasal cavity, and from the outside the doctor performs work with his hands, gently adjusting the bone and cartilage to its original position.
- If, when a fracture was received, the bone structure was crumbled, then after surgery, an additional tamponade is performed. Paraffin impregnated tampons are inserted into the nasal cavity for the purpose of proper bone fusion. Recovery time is most often 14 days.
When is anesthesia needed?
Anesthesia during reposition is used only when the fracture has occurred on the nasal septum. This procedure is considered more complex and time-consuming, during which the doctor may need to install implants in the nose. When a hematoma appears on the nasal septum, it is immediately eliminated. Otherwise, the patient may experience some complications, for example, cartilage necrosis .
Feedback on the procedure
Many patients leave positive feedback about such a procedure during a fracture. Speaking about whether it is painful to straighten the nose, patients note the painlessness of such therapy, since before it the doctor introduces a special anesthesia. In more complex cases, to avoid pain, doctors have to resort to anesthesia.
Hospitalization of the patient is carried out only with severe deformation of the nasal bones, with prolonged and recurrent bleeding, as well as with a complicated fracture associated with damage to the sinuses of the nose, brain and orbits.