Nasal trauma
Skeletal injury of the head and neck are not unusual and may
arise from
►personal insult :blow to the nose from the side or infront
►►personal accident
►►►sport injury
►►►►RTA
Aetiology
Pathogenesis
◙ no fracture
Just oedema and bleeding.this occur in low velocity trauma
but could lead to septal deviation due to displacement of
maxillary crest
◙ Class 1 fracture
Usually due to frontal or fronto-lateral blow result in
vertical fracture of the septum-chevallet fracture- with
depressed or distal portion of the nasal bone
◙ Class II fracture
It is nearly always due to lateral trauma,result in horizontal
fracture of the septum-Jarjavay fracture- or C shape fracture
of the septum involving the perpendicular plate of ethmoid
and septal cartilage with fracture of upper nose or frontal
process of maxilla,here the velocity is more than class I
◙ Class III fracture
The force is foreward ,the velocity is very high like RTA and
here all facial bones could be involved even ethmoid
labrynth,cribriform plate of ethmoid, can lead to CSF
rhinorrhea,this fracture produce a pig like nose,i.e elevation
of the nostrils and suddeling of nose with widening of nasal
bridge so increase space between eyes(telecanthus)
All types of fractures could be seen and in addition to soft
tissue damage like nasalacrimal duct damage.
Management
How and when the injury was sustained-- time and
mechanism of trauma
Other injuries may also be present and may have been
overlooked
There will be certain degree of nasal obstruction
Diplopia,visual disturbance and epiphora suggest orbital
trauma
Loose teeth and altered bite or trismus indicate the need of
dental opinion
Watery rhinorrhea ,loss of smellthough uncommon,signall
possible skull base damage and need more detailed evaluation
Examination may be difficult in the acute situation when
swelling may hide an underlying abnormality ,a second
inspection afew days later 5-7 days may be necessary
Gently palpate the nasal bones for a step deformity ,any
surgical emphysema that could suggest a more serious injury.
Look if there is any soft tissue laceration.
Inspect the nasal cavities and check for the presence of septal
haematoma or deviation
Then don’t forget to make a thorough
general ENT /head &neck examination.
Treatment
If no fracture or deformity just conservative like manage the
epistaxis properly ,analgesia and reassurance
If fracture seen early and there is nooedema and swelling so
do close reduction under LA or short acting GA disimpaction
& realignment can usually be achieved with digital pressure
or walsham`s forceps : elevation of fractured bones then
packing and P.O.P splint for one week
If fracture seen later then will be much swelling ,so
manipulation should be delayed for 5-7 days ,manipulation
should never be delayed more than 2 weeksbecause the bones
should be fixed ,calus formation and reduction should be
difficult if not impossible
There are two treatment modalities for the broken nose ,the
closed reduction method which involves repositioning the
dislocated parts of the nasal bone&can be achieved under
local or general anaesthesia as mentioned above
Or
Open reduction in which the the septum is also explored and
injuries corrected
After 2 weeks reduction is difficult ,so leave until the
condition is settled then do septorhinoplasty after 6 months
☻you have to distinguish between recent trauma and old
deformity especially in patient with frequent injury likr
sportman and frequent fighters
Septal haematoma
It is due to collection of blood beneath the
mucoprechondrium of the nasal septum this collection
interfere with the vitality of the cartilage ,the cartilage remain
viable for 3 days more than 3 days the chondrocyte die lead
to absorption of the cartilage
Clinical pictures
ruction---complete bilateral nasal obstruction
Discomfort
Septal swelling soft red in colour
Complication
Septal abcess
Cartilage necrosis
Nasal suddle deformity
Treatment
Simple aspiration ---if haematoma is small
Incision and drainage
Packing to obliterate dead space with or without quilting
suture
Systemic AB
Septal abcess
Mostly due to trauma 75%
Infective –measle,scarlet fever,furenculosis,AIDS.
Complicate ethmoid and sphenoid sinus infection
Complication
Spread infection to orbit,meningies,brain,cavernous sinus
Clinical pictures
Sever pain
Septal swelling
Nasal obstruction
Pyrexia
Treatment
Immediate drainage
Systemic AB
Reconstruction of the defect in the acute phase will reduce
growth impactionies