Generality
A broken nose is an injury characterized by the fracture of one or both nasal bones. In general, this fracture has a traumatic origin, so much so that the problem tends to interest more commonly the people involved in car accidents, who practice contact sports (such as rugby, football, boxing etc.) or protagonists of physical struggles.
An objective examination is sufficient to diagnose a broken nose.
The therapy depends on the severity of the injury: if the latter is particularly serious, a surgical intervention may also be necessary.
Definition
A broken nose is an injury that occurs when, after a facial injury, the nasal bone structure breaks.
BONE ANATOMY OF THE NOSE
Figure : detail of facial bones and skull; note how the ethmoid is considered a skull bone. From wikipedia.org
Classic situations where you can break your nose.
- During contact sports, such as rugby
- Physical struggles
- Car accidents
- Accidental falls to the ground
- Involuntary collisions, against doors or other objects
The bones of the nose, or nasal bones, are two, have a rectangular shape and are positioned next to each other, just below the frontal bone of the skull. Their size varies from person to person and these, together with the osteo-cartilaginous portion that constitutes the nasal septum, determine the shape of an individual's nose.
The bones of the nose border on:
- The jaw bones, in latero-inferior position
- The lacrimal bones, in a latero-superior position
- The ethmoid, in a postero-superior position
- The ploughshare, in a postero-inferior position
Causes
The nose can break due to a blow, which came in full face (facial trauma), of such intensity as to fracture one or both nasal bones.
The classic situations in which this can happen are: car accidents, disputes that result in violent physical contact, contact sports (such as rugby, football, hockey, etc.) and accidental falls to the ground.
RISK FACTORS
The greatest risks came from:
- Those who practice contact sports, especially if they train daily and do not wear the protections provided.
- Risque people, who "like" to be protagonists of very heated arguments and quarrels.
- Those who, in driving a vehicle, have the bad habit of not fastening their seatbelts.
- Cyclists, sportsmen and not only.
- Those who practice weight lifting without adequate equipment.
Symptoms and Complications
The condition of a broken nose involves: sense of soreness and local pain, which become more acute to the touch; swelling of the nose and surrounding areas; nose bleed; hematomas around the nose and under the eyes; crooked or deformed nose; breathing difficulties; incessant release of mucus from the nostrils; finally, sensation of one or both closed nostrils.
WHEN DOES THE BROKEN NOSE BECOME AN EMERGENCY?
After a facial trauma that has involved the nose, it is advisable to consult a doctor for a consultation or for an immediate intervention if:
- there was also a trauma to the head, which triggered headaches, neck pain, vomiting and loss of consciousness.
- The individual does not breathe.
- Loss of blood (or hemorrhage) from the nose shows no sign of stopping.
- The nose is not only swollen, but it definitely changes shape.
- From the nasal nostrils, a clear and watery fluid descends.
COMPLICATIONS
If the impact that the trauma generates is particularly strong, or if the right and timely therapeutic remedies are not applied, the broken nose can lead to various complications.
First of all, the nasal septum could undergo a deviation ( deviated nasal septum ) with narrowing or even blocking of one of the two nostrils.
Secondly, there is the possibility that the blood spilled after the trauma clots at the nasal septum and forms the so-called septal hematoma . The formation of a septal hematoma can dangerously block one or both nostrils and, if not drained, can damage nearby cartilaginous structures.
The third possible complication is the rupture of the nasal cartilage (set of structures important for supporting the nose and contributing to delineating the forms). The latter usually occurs when the trauma is very strong; requires immediate surgery.
Finally, the fourth and final noteworthy complication concerns the possibility of a neck injury . Very strong impacts on the nose can, in fact, affect the cervical bones; in these cases, the doctor must intervene immediately.
Diagnosis
In most cases, careful physical examination is sufficient to establish that the nose is broken.
Instrumental examinations, such as X-rays and CT ( computerized axial tomography ), are only considered if the facial trauma has been very strong and has also affected the neck and head.
EXAMINATION OBJECTIVE
During the physical examination the doctor examines the nose by carefully palpating the swollen areas and visually exploring the internal cavities of the nasal nostrils.
Usually, in order for the patient not to suffer from pain during these checks, the doctor uses local anesthetics which he delivers by spray or by injection.
Treatment
The therapeutic treatment for a broken nose depends on the severity of the fracture.
For a minor injury, it is sufficient to wait for natural healing; for a moderate or severe injury, on the other hand, a manual, if not a surgical, realignment is needed.
Ice, painkillers and some other simple remedies alleviate the most annoying symptoms, such as pain, swelling and blood loss.
IN THE EVENT OF LIEVENT INJURIES
Individuals with a mild nose fracture do not need specific treatment, but only have to wait for the natural healing of broken nasal bones.
To relieve pain and swelling, it is essential to apply ice to the affected area, take painkillers (such as paracetamol ) and take care to keep the head up during the night.
Figure: external splint for the nose. The splints can sometimes be internal.
In general, the swelling passes within a week, while the hematoma is reabsorbed after about 14 days.
MANUAL RE-ALIGNMENT
Cases of moderate broken nose can be treated with a manual realignment intervention ; during surgery, the doctor adjusts the position of the nasal bones also thanks to special instruments.
The manual realignment procedure requires local anesthesia (practiced with an injection or a nasal spray) and must be performed within 14 days of the fracture, ie before the fractured bones calcify.
After calcification, the only solution is surgery.
Post-intervention phase
After the operation, the surgeon bandages to protect the nose and associates a sort of splint to maintain alignment. Bandages and splints should be kept for about a week.
Antibiotics may be prescribed to the patient to prevent infection.
The planned rest period is at least two weeks.
SURGICAL INTERVENTION
Surgery is required in the event of:
- Severe fracture
- Multiple fracture
- Moderate fracture not fixed in a timely manner with the manual realignment intervention.
- Bone fracture associated with a severe deviation of the nasal septum. In this case, a septoplasty is also performed.
Figure: first (left) and after (right) surgery.
The surgical operation has the same purpose as the manual realignment procedure (thus adjusting the position of the nasal bones), but unlike the latter it is more invasive (incisions are planned) and requires general anesthesia .
The post-operative phase provides absolute rest for at least two weeks.
USEFUL REMEDIES FOR A BETTER RECOVERY
Regardless of the severity of the fracture, the best remedies for alleviating the symptoms and recovering the best are:
- Keep your head forward so as to prevent the blood from leaking out of your throat.
- Apply ice immediately on the affected area. The best thing is to make 4-5 packs a day, lasting at least 10-15 minutes each. This is called cryotherapy ("cold therapy"), which is highly effective in reducing swelling and a sense of pain.
- Take painkillers . Paracetamol and ibuprofen (which is a NSAID) are particularly suitable.
- Keep your head raised in relation to the rest of the body, when you go to sleep, so as to avoid a worsening of the swelling.
- Stand at rest until healing has occurred and avoid any dangerous sport for at least 6 weeks.
Prevention
Always fasten seat belts (even for short journeys), wear the protections provided in certain sports (also in training) and, finally, get a bike helmet, the three most important preventive measures to avoid injuries such as a broken nose.
