Jubilee Hospital, Trivandrum.
Nasal bone fractures are the third most common fracture. Common causes of nasal bone fractures are traumatic injuries. Symptoms of a nasal fracture include external nasal deformity, nose bleed, facial pain, facial swelling, facial tenderness, facial bruising, a deformed nose, and the inability to breathe normally though the nose. Immediate treatment for nasal bone fractures may include cold compresses, nasal packing, nonsteroidal anti-inflammatory and analgesics.
ENT examination and Imaging studies-Plain x-ray nasal bones and CT scan of the facial bones.
Reduction of fracture nasal bone can be done immediately after injury but once edema develops, it is better to wait a wee until the swelling goes.
Manual realignment is the easiest method of closed reduction. Two instruments, the Asch and the Walsham forceps, are designed to reduce the displaced septum and impacted nasal bones, respectively, although these instruments often are used interchangeably. An important drawback with these instruments is the possibility of mucosal crushing injuries and resulting hematomas that may occur between their tines.
The procedure can be done under local anesthetic or general anesthetic.
If septal correction and draining septal haematoma is needed, it is better to do the procedure under GA.
An intranasal silastic splint, merocel packing and external thermoplastic is needed for stabilization.
Complications of nasal bone fracture:
1. Cosmetic deformity if not corrected in time
2. Persistent septal deviation causing nasal blockage
3. CSF leak
4. Orbital edema