Nose injuries
Nasal injuries are one of the most common injuries of the facial area, which consists in a mechanically caused defect of the nasal bones or cartilage. Almost every person received minor nose injuries in childhood, however, depending on the strength of the damage and the direction of the impact, their consequences can be quite serious.
The content of the article:
Classification of nasal injuries
Curvature of the nasal septum
Treatment of nasal septum curvature
Causes of nasal injuries
Symptoms of a nose injury
Diagnosis of nasal injuries
Treatment of nasal injuries
Nose injuries
Classification of nasal injuries
Like any other injuries, nasal injuries are divided, first of all, into closed and open — depending on whether there has been a violation of the integrity of the skin. In turn, open injuries can be divided into penetrating and non-penetrating into the nasal cavity.
A more specific classification is based on the degree of damage:
soft tissues are damaged;
damaged nasal cartilages;
the bone structures of the nose are damaged.
Injuries to the soft tissues of the nose usually include bruises and wounds of mild degrees, not associated with the separation of the external nose.
When it comes to injury to the nasal cartilage, most often it means damage to the nasal septum, which divides the nasal cavity in two and is a continuation of the latticed bone.
A fracture of the bones of the nose can be either with or without displacement of fragments. The fracture of the nasal septum should be mentioned separately. Sometimes it does not break completely: on the one hand, the nose looks completely intact, and the fracture is present only on the other. In addition, often the nasal septum simply sinks with a traumatic effect, and it is not easy to distinguish such a phenomenon from a fracture. In order to avoid distortion, it is not recommended to try to put it in place yourself.
Separately, it is worth noting the injuries of the nose that are not mechanical in nature — thermal, chemical and even electrical burns.
Curvature of the nasal septum
The curvature of the nasal septum may be due to physiological, compensatory or traumatic mechanisms. By physiological, we mean a violation of the development of the facial skeleton. With injuries, a fracture occurs more often, but the curvature itself is usually the result of improper bone fusion after the fracture.
The main symptoms of nasal septum curvature are:
feeling of dryness in the nasal cavity;
labored nasal breathing;
frequent diseases of the paranasal sinuses (often chronic);
snoring;
allergy.
It is impossible not to mention the cosmetic defect, which consists in shifting the nose to the left or right.
Treatment of nasal septum curvature
Doctors of the “old school” prefer the Killian method, which has been known since the beginning of the last century. It involves an incision and detachment of the mucosa to remove the deformed portion of the nasal septum. Then, for five days, the mucosa is pressed with a gauze swab.
However, this method is fraught with the destruction of cartilage in the future, since along with the deformed area, the covering cartilage is also removed. The mucosa is located on it, and after removal of the cartilage, it turns out to be open to a constant flow of air. This leads to the drying of the mucosa, its thinning and the formation of a hole exposing the cartilage.
Modern techniques using an endoscope are less traumatic. They allow you to get close to the deformed area without damaging the mucosa. The cut-out area is returned to its lost shape with the help of a special device and returned to its place, fixing it with silicone plates.
Causes of nasal injuries
In childhood, most often nose injuries are of a domestic nature: an unsuccessful fall and inability to group correctly almost always leads to bruising and bleeding.
In adolescence, the causes of nose injuries are usually accidents during sports, as well as fights. Because of this, boys face a similar problem about twice as often as girls. For the same reason, the curvature of the nose is usually found in the stronger sex.
Among adults, common causes of nose injuries are also fights, sports, and accidents.
Symptoms of a nose injury
There are symptoms characteristic of any nasal injuries. These include:
bleeding;
pain;
difficulty in nasal breathing;
the formation of a hematoma (when the injury affects the nasal septum).
It is worth noting that the intensity of bleeding does not depend on the degree of damage. In patients with poor blood clotting or hypertension, it will be quite strong in any circumstances.
The difficulty of nasal breathing is caused by the accumulation of blood under the mucous membrane, and a hematoma formed from blood flowing into the soft tissues of the nose can block the lumen of the nasal passages. If the hematoma is not removed in time, then suppuration begins, which is evidenced by the following symptoms:
temperature jump;
headache;
sharp pain in the nose area.
In the future, cartilage destruction and deformation of the nasal septum may follow, so it is impossible to delay treatment.
Fracture of the nasal cartilage, in addition to the above symptoms, is accompanied by a noticeable change in the shape of the external nose:
the back is trapped;
the entrapment of stingrays;
scoliosis of the back.
Sinking of the back of the nose, as a rule, occurs as a result of a direct blow. In this case, either there is a fracture of the nose in the longitudinal direction, or the nasal bones are separated.
Scoliosis of the nasal dorsum is usually caused by a side impact, as a result of which the frontal process breaks off from the nasal bone and breaks on the opposite side. Moreover, such an injury never goes away without consequences for the nasal septum (dislocation or fracture).
Dangerous symptoms that may indicate serious damage that is not visually recognizable at first are:
severe and long-lasting bleeding (if it is not caused by other physiological characteristics of the victim);
lacrimation indicating damage to the lacrimal tract or eye socket;
discharge of cerebrospinal fluid, indicating a fracture of the latticed bone.
It is worth paying special attention to the leaking cerebrospinal fluid. At first glance, it is not difficult to confuse it with ordinary tears — it is a clear liquid. Therefore, you should not postpone contacting a doctor, since this phenomenon (in medicine it is called rhinoliquorrhea) is fraught with infection of the cerebrospinal fluid and the development of life-threatening diseases such as encephalitis or meningitis.
If we are really talking about lacrimation, it means that the side wall of the nose is broken, and the lacrimal sac or nasolacrimal canal is affected.
Thus, any injuries and curvature of the nose require urgent medical attention.
Diagnosis of nasal injuries
Diagnostic measures begin with a conversation with the victim, since it is important for the doctor to establish under what circumstances the nose injury was sustained. The next stage will be an inspection, including:
determination of the nature of the injury (open or closed);
assessment of bleeding intensity;
assessment of the shape of the nose and its external condition as a whole;
detection of hemorrhages in the soft tissues of the nose;
assessment of the condition of the suborbital area and conjunctiva.
Palpation will help clarify the data obtained during the examination.
In case of serious injuries, the doctor may prescribe a rhinoscopy, which will show:
the presence of a foreign body in the nasal cavity and its location;
the degree of narrowing of the nasal passages;
displacement of bone walls;
the risk of hematoma formation.
If there is a suspicion of a fracture, an additional X-ray of the nasal bones will be prescribed. Given that a nose injury may be accompanied by a concussion, the doctor may prefer an X-ray of the entire skull. However, a more informative method in this case will be a computer or magnetic resonance imaging, which will eliminate the consequences.
If this diagnosis is confirmed, the victim will also need to be examined by a neurologist.
Treatment of nasal injuries
Medical care can be refused only in the case of mild injuries to the soft tissues of the nose and their closed nature. It is enough to apply ice to soothe the wound. Bleeding can be stopped by an anterior tamponade.
If there is a more serious injury to the nose, treatment should be carried out immediately. This is especially true for fractures: the restoration of the nose without consequences is possible only within a few hours after receiving damage.
In the case of a broken nose , the doctor faces two tasks:
restore the physiological functions of a damaged nose;
restore its external form.
First of all, it is necessary to stop the bleeding, and we are not talking about household tamponade, namely professional surgical treatment. In the absence of bone displacement, special tampons soaked in a three percent solution of hydrogen peroxide are inserted into the cavity.
When bones are displaced, their reduction becomes a priority, carried out endonasally under anesthesia.
