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Doc: I think I busted my nose! What should I do?

Good morning and TGIF!

Welcome to another Euan's ENT fortnightly blogpost!

Today's topic is on nasal injuries or fractures. What can or should you do if you have injured your nose?

A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose — often the bone over the bridge of your nose.

Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in injuries to the face.

A broken nose can cause pain, and it is common to get a nosebleed. You may have swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing through it.

Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary.

Nose injuries can arise from many situations such as contact sports, fights, or accidents

A fractured nose is the most common fracture of the face. It most often occurs after an injury and often occurs with other fractures of the face.

Nose injuries and neck injuries are often seen together. A blow that is forceful enough to injure the nose may be hard enough to injure the neck.

Serious nose injuries cause problems that need a healthcare provider's attention right away. For example, damage to the cartilage can cause a collection of blood to form inside the nose. If this blood is not drained right away, it can cause an abscess or a permanent deformity that blocks the nose. It may lead to tissue death and cause the nose to collapse.

For minor nose injuries, the healthcare provider may want to see the person within the first week after the injury to see if the nose has moved out of its normal shape.

Sometimes, surgery may be needed to correct a nose or septum that has been bent out of shape by an injury. A doctor may be able to return nasal bones that have moved out of place back to their normal position within the first 2 weeks after the break. After this period, the bones begin to set in place, and may require re-breaking (osteotomies) to re-position the bones.

Q: Who is more likely to sustain a nasal injury?

Any activity that increases your risk of injuries to the face can increase your risk of a broken nose.

Such activities may include:

  • Playing contact sports, such as football and hockey, especially without a helmet that has a face mask

  • Engaging in a physical fight

  • Riding a bicycle

  • Lifting weights, especially if you don't use a spotter

  • Riding in a motor vehicle, especially without a seat belt

When doing activities with high risk of nose injuries, it is strongly advised to wear proper protective headwear

Q: What are the common symptoms of a nasal bone fracture?

Signs and symptoms of a broken nose include:

  • Pain or tenderness, especially when touching your nose

  • Swelling of your nose and surrounding areas

  • Bleeding from your nose

  • Bruising around your nose or eyes

  • Crooked or misshapen nose

  • Difficulty breathing through your nose

  • Discharge of mucus from your nose

  • Feeling that one or both of your nasal passages are blocked

Pain, bleeding or bruising around the nose may be signs of a broken nose following a traumatic incident

Q: When should I see a doctor?

Do seek emergency medical attention if you experience a nose injury accompanied by:

  • A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness

  • Difficulty breathing

  • Bleeding you cannot stop

  • A noticeable change in the shape of your nose that is not related to swelling, such as a crooked or twisted appearance

  • Clear, watery fluid draining from your nose, which may indicate a more serious injury to the base of the skull (anterior cranial fossa)

Q: What are the possible complications?

Complications or injuries related to a broken nose may include:

  • Deviated Nasal Septum. A nose fracture may cause a deviated septum. This condition occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced, narrowing your nasal passage. Medications, such as decongestants and antihistamines, can help you manage a deviated septum. Surgery is sometimes required to correct the condition.

  • Collection of blood. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal haematoma. A septal haematoma can block one or both nostrils. It requires prompt surgical drainage to prevent cartilage damage & necrosis.

  • Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you also may experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgeon will address both your bone and cartilage injuries.

  • Neck injury. If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck. If you suspect a neck injury, seek medical care immediately at the A & E Department for cervical spine injuries.

Q: How can I reduce the risk of getting a nasal injury?

You can help prevent a nose fracture by following these guidelines:

  • Wear your seat belt when traveling in a motorised vehicle, and keep children restrained in age-appropriate child safety seats.

  • Wear the recommended safety equipment, such as a helmet with a face mask, when playing hockey, football or other contact sports.

  • Wear a helmet during bicycle or motorcycle rides.

Thank you for your attention to this week's blog. If you would like to seek treatment for any nasal trauma or fractures, or other ENT issues, please feel free to contact us at Euan's ENT Surgery & Clinic to book an appointment.

If you are interested in finding out more, do look up the following references:

References :

1. Murray JA. Management of septal deviation with nasal fractures. Facial Plast Surg. 1989;6(2):88-94.

2. Nahum AM. The biomechanics of maxillofacial trauma. Clin Plast Surg. 1975;2(1):59-64.

3. Courtney MJ, Rajapakse Y, Duncan G, Morrissey G. Nasal fracture manipulation: a comparative study of general and local anaesthesia techniques. Clin Otolaryngol Allied Sci. 2003;28(5):472-5.

4. Park HK, Lee JY, Song JM, Kim TS, Shin SH. The Retrospective Study of Closed Reduction of Nasal Bone Fracture. Maxillofac Plast Reconstr Surg. 2014;36(6):266-72.

5. Small EW. Survey of maxillofacial fractures. J Oral Surg. 1976;34(1):27-8.

6. Logan M, Driscoll K, Masterson J. The utility of nasal bone radiographs in nasal trauma. Clin Radiol. 1994;49(3):192-4.

7.Turvey TA. Midfacial fractures: a retrospective analysis of 593 cases. J Oral Surg. 1977;35(11):887-91.

8. Wild DC, Alami MA, Conboy PJ. Reduction of nasal fractures under local anaesthesia: an acceptable practice? Surgeon. 2003;1(1):45-7.

9. Khwaja S, Pahade AV, Luff D, Green MW, Green KM. Nasal fracture reduction: local versus general anaesthesia. Rhinology. 2007;45(1):83-8.

10. Cook JA, Rae RD, Irving RM, Dowie LN. A randomized comparison of manipulation of the fractured nose under local and general anaesthesia. Clin Otolaryngol Allied Sci. 1990;15(4):343-6.


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