Dr.K.O.Paulose FRCS, DLO.Consultant ENT Surgeon.
Jubilee Hospital, Trivandrum, Kerala, South India
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. Although fractures involving the nasal bones are very common, it is often ignored by the patient. These patients can be easily treated by closed reduction of the nasal bones. If the nasal bones had become impacted then it will be necessary to disimpact the fragment before attempting repositioning.
Technique of manipulation of nasal bone fractures
Fractures of the Nasal bone fractures are among the most common facial bone fractures- comprise up to 50% of all facial fractures.
Most nasal fractures are diagnosed by history and physical examination. History usually includes a preexisting trauma, which may be followed by epistaxis. Typically, the epistaxis has resolved by the time the patient presents for intervention.
This patient had sustained fracture of nasal bone 2 weeks ago. These patients can be easily treated by closed reduction of the nasal bones. If the nasal bones had become impacted then it will be necessary to disimpact the fragment before attempting repositioning. This patient also had associated fracture of the nasal septal cartilage, hence it should also be reduced. Reduction of fractured septal cartilage is very important because it is the septum that governs the ultimate shape of the nose.
The patient is anesthetized and intubated, draped. A Welsham forceps is used to disimpact the fractured fragment of the nasal bone. The surgeon now moves to the head end of the patient. Using index and thumb of both hands the surgeon kneads the nasal bone fragments into position. The septal cartilage is elevated using Ash’s forceps. The nasal cavities are packed with merocel if any bleeding. The reduced nasal bones are stabilized using a thermoplast cast.
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