Nasal fracture
Dr. med. Mira Seidel is a freelance writer for the medical team.
More about the experts All content is checked by medical journalists.A nasal fracture is a break in the bony structures of the nose. The cause is often direct violence, for example a punch in the face. Typical symptoms of a broken nose are nosebleeds, red eyes and a deformed nose structure. Cooling and pain relievers are sometimes sufficient treatment. In the case of a severe nasal fracture, however, the nose must be treated surgically. Find out more about broken nasal bone.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S02
Nose fracture: description
The nasal bone fracture is one of the most common injuries in the head and neck area. Nose fractures are more than half of all facial fractures. This is because less force is sufficient for this than for breaking other facial bones.
Anatomy of the nose
The structure of the nose is bony in the area of the bridge of the nose. The bone consists of the two nasal bones (ossa nasalia) and the two flat protrusions of the upper jawbone (processus frontales of the maxilla). They form the front nostril, which is supplemented by the cartilage. The paired triangular cartilage plate (cartilago nasi lateralis) forms the lateral nasal wall, the bridge of the nose and bends in the middle into the nasal septum. The two nasal cartilages form the nostrils.
The anatomy of the nose is slightly different in children than in adults. In the offspring, the bones of the nose are shorter and the cartilaginous part is larger. Embedding it in a larger soft tissue provides additional protection for the nose. There are various growth zones in the nasal skeleton which can disrupt the development of the nose in the event of a broken nasal bone.
Broken nose: symptoms
If there is swelling around the nasal bone (such as after falling or being hit on the nose), the nose may have broken. Symptoms such as a displaced nasal framework and its abnormal mobility reinforce the suspicion of a fracture. Sometimes one also observes extensive bleeding under the conjunctiva (hyposphagma) in the eyes. Since the mucous membranes are almost always injured when a nasal bone fractures, nosebleeds often occur immediately after the trauma, but this stops after a few minutes. The nose is later blocked by the resulting swelling and bleeding.
Broken nose: cause
The cause of a nasal bone fracture is usually a blunt frontal or lateral force on the nose.
A blow to the front part of the nose causes the nasal septum to break. The bony nasal bone and the nasal septum can shift or the nasal septum detaches from the bony groove at the bottom of the nasal cavity.
A broken nose is the result of a greater amount of violence. In addition to the nasal bone, the fracture often also includes the two flat protrusions of the upper jawbone and sometimes also the two tear bones. The nasal septum is usually broken as well. As a result, a saddle nose or a bony crooked nose in the event of lateral force.
Nose fracture: examinations and diagnosis
If you suspect a broken nose, you should consult an ear, nose and throat specialist. The doctor will first ask you exactly how the accident happened and your medical history (anamnesis). Possible questions are:
- Did you fall on your nose or was there direct violence on your nose?
- What is the exact course of the accident?
- Are you still getting air through your nose?
- Do you have pain?
The doctor then conducts a clinical examination. He inspects the nose and carefully feels the nasal framework for bone edges and steps. A crunch can be heard and felt.
In addition, the doctor examines the inside of the nose by means of a nasal examination (rhinoscopy). In this way, he can determine whether the nasal septum has a bruise, is displaced, or whether the mucous membranes are torn or bleeding. The doctor can also see if bone lamellae are sprouting through.
Nose bone fracture: diagnostic apparatus
The diagnosis of a broken nasal bone can be confirmed with x-rays of the paranasal sinuses and the side of the nose. Fracture lines in the area of the nasal pyramid, the frontal processes and the front edge of the nasal septum are visible in the X-ray. Computed tomography (CT) is only necessary if the doctor suspects further injuries in the area of the midface (such as the floor of the orbit, the rim of the orbit, and the ethmoid cell system).
X-ray examinations should be avoided in children and pregnant women because of the radiation exposure. Instead, they can visualize a broken nasal bone using ultrasound. However, only the bone contours can be seen in the ultrasound, but not the deeper structures such as the maxillary sinuses and ethmoid cells.
Nose fracture: treatment
A nasal bone fracture should not be underestimated, as the nose can permanently deform after the accident and also suffer functional damage. Correct treatment as early as possible is therefore important. At the scene of the accident, you should first try to stop severe nosebleeds. The rest of the treatment depends on whether there is a closed, open and / or displaced nasal fracture:
Closed nasal bone fracture
If you have a closed nasal bone fracture, you should first take decongestant measures, for example carefully cooling your nose with cold compresses or ice packs. To relieve the pain, the patient can take pain relievers such as acetaminophen. The attending physician will give more detailed recommendations.
These conservative treatment measures are usually sufficient for a closed nasal bone fracture.
Open nasal fracture
With an open nasal bone fracture, the bone fragments point outward through the skin or into the inside of the nose. Extreme soft tissue injuries to the outer skin can also make bone structures visible. An open nasal bone fracture should be treated surgically as soon as possible. Among other things, the bone fragments are aligned and the wound cleaned. This is important to prevent the bone from becoming inflamed (osteomyelitis).
Displaced nasal fracture
For each displaced nasal fracture, the bone fragments should be realigned after the soft tissue has decongested, but within the first five to six days after the accident. This is done under general or local anesthesia. The bone fragments are finally stabilized from the inside with a tamponade and from the outside with a nasal cast.
The tamponade can be removed about three to five days after the operation. The plaster cast is changed on the fifth to seventh day because it loosens due to the swelling of the nose. The cast is then worn for about another week. It serves to splint the nose as much as possible and should have a good fit. Aluminum rails are usually not enough.
Nose fracture: disease course and prognosis
After a broken nose, it takes about six weeks for the bone to become stable again. During this time, the patient should avoid exercise and strenuous exercise to prevent the bone fragments from shifting again. Professional athletes can have a special nasal fracture mask made, which must be worn after the cast has been removed so as not to risk re-trauma.
Broken nose: complications
A number of complications can arise with a broken nose:
A bruise in the nasal septum is a dreaded complication. It bleeds in the area of the cartilaginous nasal septum, which means that the cartilage can no longer be nourished. The pressure of the bruise and the lack of nutrition can cause the cartilage to die. It can become infected over time, so that if left untreated, a saddle nose can develop or the nasal septum gets a hole. A bruise of the nasal septum should therefore be operated on immediately.
Heavy bleeding can occur with any injury and thus also with a broken nose. This is especially true for patients who take blood-thinning medication such as phenprocoumon (Marcumar or Falithrom) or acetylsalicylic acid for a long time. If the examination reveals a source of bleeding, the doctor can obliterate it under local anesthesia. Then he inserts a nasal packing on both sides.
In addition, a broken nasal bone always harbors the risk that the shape of the cartilaginous and / or bony nasal framework will permanently change, resulting in a crooked or saddle nose, for example.
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