Fracture Nasal bone, Broken nose

Nose is the most prominent part of the face, hence it is likely to be the most common structure to be injured in the face. Patients with fractures of nasal bone will have deformity, tenderness, hemorrhage, edema, and ecchymosed-black eye.

Nasal fractures occur in one of two ways- from a lateral impact or from a head-on impact. In lateral trauma, the nose is displaced away from the midline on the side of the injury, in head-on trauma, the nasal bones are pushed up and splayed so that the nasal bridge appears broad, but the height of the nose is collapsed -saddle-nose deformity. In both cases, the septum is often fractured and displaced.

Clinically this fracture will present as a depression over the nasal bone area. There may be tenderness and crepitus over the affected nasal bone. Radiological evidence may or may not be present.

Reduction of Fracture Nasal Bone

If fractures of nasal bones are left uncorrected it could lead to loss of structural integrity and the soft tissue changes that follow may lead to both unfavorable appearance and function. The management of nasal fractures is based solely on the clinical assessment of function and appearance; therefore, a thorough physical examination of the nose is important.

Patients with fractures involving nose will have bleeding from nose making assessment a little difficult. Bleeding must first be controlled by nasal packing. These patients also have considerable amount of swelling involving the dorsum of the nose. These patients must be conservatively managed for at least 1-2 weeks for the edema to subside to enable precise assessment of bony injury. Reduction of fracture nasal bone is done only after the edema subsides; this is usually within 5-10 days in adults and 3-7 days in children.

Radiological investigations:

1. Plain X-ray nasal bones

2. CT scan preferably 3D CT of facial bones

Nasal bone fractures can be managed by closed reduction and immobilization by application of Thermoplast and intranasal silastic splint. Digital pressure alone commonly does the job. It can be done under local anesthetic in adults and a short GA in children.

If the fractured fragments are impacted then a Welsham and Ash forceps will have to be used to disimpact and reduce the fractured nasal bone and nasal septum.

Sometimes while using Welsham forceps to disimpact the nasal bone, there will be extensive trauma to the nasal mucosa causing epistaxis. The nasal cavity of these patients must be packed with Merocel®, with application of an external splint to stabilize the bone.

Complications of nasal bone fracture, if not corrected in time

1. Cosmetic deformity (saddle nose)

2. Persistent Septal deviation

3. CSF leak

4. Orbital edema

5. Nasal obstruction, sinusitis etc