Fractured nose

Fractured nose: Excerpt from Professional Guide to Diseases (Eighth Edition)

The most common facial fracture, a fractured nose usually results from blunt injury and may be associated with other facial fractures. The fracture’s severity depends on the direction, force, and type of the blow. A severe, comminuted fracture may cause extreme swelling or bleeding that may partially obstruct the airway. Inadequate or delayed treatment may cause permanent nasal displacement, septal deviation, and obstruction.

Signs and symptoms

Immediately after injury, a nosebleed may occur, and soft-tissue swelling may quickly obscure the break. After several hours, pain, periorbital ecchymoses, and nasal displacement and deformity are prominent. Possible complications include septal hematoma, which may lead to abscess formation, resulting in avascular septal necrosis and saddle nose deformity.

Diagnosis

CONFIRMING DIAGNOSIS Palpation, X-rays, and clinical findings such as a deviated septum confirm a nasal fracture.

Diagnosis also requires a complete patient history, including the injury’s cause and the amount of nasal bleeding. Watch for clear fluid drainage, which may suggest a cerebrospinal fluid (CSF) leak and a basilar skull fracture. If the patient is pregnant, a computed tomography (CT) scan is necessary.

Treatment

Treatment restores normal facial appearance and re-establishes bilateral nasal passage after swelling subsides. Reduction of the fracture corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose and taped) maintains it. Reduction is best accomplished in the operating room under local anesthesia for adults and general anesthesia for children. Severe swelling may delay treatment. CSF leakage calls for close observation, a CT scan of the basilar skull, and antibiotic therapy; septal hematoma requires incision and drainage to prevent necrosis.

Start treatment immediately. While waiting for X-rays, apply ice packs to the nose to minimize swelling. Wrap the ice packs in a light towel to prevent ice from directly contacting the skin. To control anterior bleeding, gently apply local pressure. Posterior bleeding is rare and requires an internal tamponade applied in the emergency department.

Special considerations

❑ Because the patient will find breathing more difficult as swelling increases, instruct him to breathe slowly through his mouth. To warm the inhaled air during cold weather, tell him to cover his mouth with a handkerchief or scarf. To prevent subcutaneous emphysema or intracranial air penetration (and potential meningitis), warn him not to blow his nose.

❑ After packing and splinting, apply ice in a plastic bag.

❑ Before discharge, tell the patient that ecchymoses should fade after about 2 weeks.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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