Nasal bone reposition: what is a fracture of the nose with displacement and how is it treated



Among facial injuries, a nose fracture occurs most frequently. This injury may cause damage to the olfactory and respiratory functions. Typically, this phenomenon occurs in the domestic environment: a fall on a slippery floor, ice, a fight, but there is also a risk group - people, including athletes and motorists. The procedure, with the help of which they eliminate violations of the organ during a fracture, is called reposition of the nasal bones. To understand what could be a fracture of the nose, you should know about its structure. The nose is bordered by the skull in the upper part, with the oral cavity in the lower part and the sockets on the sides.

Bones and cartilage are located as follows:

• The outer wall, also called the lateral wall, includes the nasal bone, the palatine bone, the nasal surface of the upper jaw, the ethmoid bone, the pterygoid processes of the main bone, the frontal process and the lacrimal bone.
• The side walls are connected by a partition.
• The backside includes a vomer and a perpendicular plate of the ethmoid bone.
• Anteriorly, there is a quadrangular cartilage and a movable part of the septum.
• The upper wall is formed by a thin trellis plate, which is easily damaged by injury.
• From the side of the nose are large and small prylny cartilage.

Most often, we can deal with injuries in the external nasal bones, rarely traumatizing the walls of the orbits, the vomer, the frontal processes and the concha.

What are bone fractures?



• Closed form - visible manifestations are mild (abrasions and swelling).
• The open form is characterized by wounds on the skin, you can see fragments of bones.
• With displacement - the nose becomes asymmetrical (may be accompanied by external skin damage or have the characteristics of a closed form).
• Damage to the nasal septum - the nose sinks inward.

It is necessary to know the symptoms of a nose fracture in order to consult a specialist for treatment in time. This is especially important if the injury occurred in a child, since later the nose may not be formed correctly, leading to curvature of the organ, breathing difficulties and ENT diseases.

How to recognize a nose fracture:



• blood flows (there can be both abundant and meager discharge);
• possible shock and loss of consciousness;
• the skin around the nose, eyes and cheekbones becomes edematous;
• red streaks are visible in the eyeballs;
• breathing is difficult, frequent stabbing;
• there are wounds, shards are sometimes visible;
• nose hurts, touching it causes acute pain;
• bruises appeared in the injury site and under the eyes.

In addition to the primary signs that manifest themselves during the first days after the fracture, a fever, redness at the fracture site, and softening of the tissues are possible. Such manifestations on the second, third day after injury indicate infection of wounds with pathogens.

How to diagnose a nose fracture:

• using rhinoscopy determine the areas of rupture of soft tissues;
• To determine if the patient is displaced, an x-ray of the side of the nose is taken;
• inspection of internal damage is carried out with an endoscope;
• the patient is prescribed laboratory tests of blood and urine.

After diagnosis, the doctor prescribes a treatment that matches the individual case. The treatment areas for nasal bone fractures are as follows:

• First aid includes applying cold compress (ice) to the affected area in order to relieve swelling and reduce pain.
• With severe pain, pain and sedatives are given to the patient.
• A tetanus shot is given.
• If the bone has moved or crumbled during a fracture, reposition is performed.

Reposition of the bones of the nose is carried out in a limited time. From the moment of injury to the bone reduction procedure, no more than 21 days should pass. The optimal time for the operation is from 5 hours to 7 days.

If the patient turned immediately after the fracture, but there is a strong swelling of the nose, then the reposition is postponed for several days, until the condition of the soft tissues is normalized. After the tenth day after the fracture, it is more difficult to perform reposition, as a callus begins to form. In this case, the doctor is forced to fasten the assigned area with a special bandage.

After a three-week period after a nose fracture, reposition is impossible. The operation is postponed for at least six months, so that the bones fully grow together.

In order to correct an uneven accretion, a complicated operation under general anesthesia is required. The doctor breaks the bones again, in the place of uneven accretion and puts them in the correct position.

Depending on the type of fracture with an offset, the doctor chooses a method of setting bones in place. It depends on how easy and quick the procedure is.

There are several types of fracture of the nose, in which reposition is performed:

• When the back of the nose sinks, they talk about rhinolordosis.
• If the nose is strongly pressed inwards and visually looks like a wide or short one, then such a fracture is called platinia.
• If the nose is shifted to the side, then it is rhinoscliosis.
• The formation of a humpback nose is called rhinophilus.

If the patient shows reposition of the nasal bones, the treatment includes several steps:

1. Preparation for surgery includes measures to relieve a painful shock in a patient and eliminate edema, which is formed in the nasal passages and sinuses. To stop bleeding make tamponade.
2. Anesthesia of the fracture site is performed using local anesthesia by administering a medicine with a syringe or irrigation (lubrication) of the damaged part with an anesthetic.
3. Repositioning is done manually or using special elevators. If they are absent, they are replaced with tweezers, the ends of which are wrapped with cloth, and a rubber tube is put on top. The elevator is placed in the nose, and from the outside, the surgeon works with his fingers, setting the bones in place.
4. If the fracture is characterized by a multitude of bone fragments, then after the operation tamponade is performed. Tampons soaked in paraffin are placed in the nasal cavity so that the bones heal properly. The recovery period with tamponade usually takes a little over a week.

Anesthesia for reposition is applied in case of a fracture of the nasal septum. This operation is more difficult, during it implantation in the nose is not excluded. In the event of a hematoma on the nasal septum, it is immediately drained. Otherwise, complications such as cartilage necrosis are likely to occur.

In which cases the patient is hospitalized:

• severe external deformity of the nose;
• excessive or recurrent bleeding;
• complicated fracture with damage to orbits, brain, nasal sinuses.

During the recovery of the nose after reposition, the patient should observe certain rules:

• It is forbidden to visit the bath or sauna.
• Do not wear glasses.
• Situations in which a nose can be struck should be avoided, for example, sports events, ball games.
• Eliminate physical activity.
• If breathing is difficult as a result of edema, vasoconstrictor drops should be used.

If necessary measures are not taken with respect to a broken nose, then negative consequences may arise.

• Formed hematoma septum of the nose. If it is not timely removed, then necrosis (destruction) of cartilage is possible. Hematoma is removed surgically.
• The bones of the nose grow together crookedly, leaving a pronounced cosmetic defect.
• Deformation of the internal nose contributes to loss of smell and respiratory failure. These diseases, in turn, give rise to common ailments: the trigeminal neuralgia, migraine, asthma and others. Stenosis of the induction tract (lacrimal canal, sinuses) can cause chronic diseases of the nose and eyes.

Straightening the nose after a fracture: effective techniques

In order to effectively reposition the nasal bones, it is necessary to accurately diagnose the sites of damage and the condition of the body as a whole. Injuries to the nose entail swelling and bleeding. These symptoms should preferably be removed before reposition. Often the patient has a concussion. In this case, the operation is postponed for several days until the patient's condition improves.

Children are characterized by injuries with sticking out of the nose without bone fractures. This is due to the age characteristics of the bone tissue, which contains more elastic fibers than an adult. But in this case, an operation is also carried out to restore the normal position of the nasal septum.

The optimal time to reduce the nose - the first few days after injury. If a patient has a fracture of the bones of the nose with an offset, then treatment is carried out before reposition. The sooner the patient is seen by the doctor, the faster the diagnosis of the fracture, preparation for the operation, and reposition of the bones will take place. If the patient turned to the doctor in a day, two, then severe edema, emphysema, wound inflammation and other phenomena make the diagnosis difficult and sometimes impossible. In this case, you have to wait until the condition of the soft tissues is normalized.

Nasal bone fracture treatment with displacement

1. With abundant bleeding is a tamponade. It is desirable to perform it after the diagnosis of a fracture, if the displacement is insignificant, then, in addition to stopping the blood, the procedure may contribute to the reduction of the bones. In this case, the doctor makes sure that this procedure does no more harm, which is possible in inept hands. If the tampon or turunda is inserted coarsely, soft tissue damage and separation of bone fragments may occur.
2. Tamponade is done with tampons or long turunds that overlap each other. Tampons are soaked with cocaine adrenaline and inserted into the nasal passages. The procedure is performed 2-3 times a day for 1-3 days.
3. If the fracture has an open form, then the doctor treats the open wound with hydrogen peroxide solution or saline, cleansing it from dirt, sand, blood clots. Separate bone fragments, unbound, are retrieved. They try to leave even the smallest fragments, if they have even a weak connection with soft tissues.
4. After washing the wound, the doctor assesses her condition and if she is fresh and not inflamed, she sews up. In the case of infection entering the wound, especially in the presence of purulent contents, the wound is left open for treatment. The patient is prescribed antibiotics, and the damaged place is treated with antibacterial agents. Emphysema usually disappears itself after a few days.
5. In the case of the formation of a hematoma of the nasal septum, the doctor removes it surgically.

Effective nose straightening after fracture

1. For the operation, the doctor puts the patient on the couch. This is done so that the patient does not fall in case of shock. The operation lasts a few seconds, but is accompanied by acute pain.
2. The nasal mucosa is treated with a solution of cocaine with adrenaline, in addition make an injection of novocaine under the skin. In case of complicated fractures, general anesthesia may be recommended to adults and children to reduce the nose.
3. As soon as the anesthetic has worked, the doctor sets his nose with his fingers and, if necessary, uses an elevator. At the time of the operation, the patient hears a crunch of bone that has risen in place. The doctor's actions to straighten the nose after a fracture differ, depending on the nature of the injury.
   • Fracture of the nose with an offset to the side . The surgeon adjusts his nose in this situation with his thumbs, pressing down on the bone that was dislodged. Here the main thing is to accurately determine the point on which to act. If a retraction occurred on one side only, the doctor inserts an elevator into the nasal cavity and squeezes a piece of bone out.
   • Dropping the back of the nose . The operation to restore the nose is sometimes carried out with the fingers, but more often they use elevators. To do this, with two instruments inserted into the nasal passages, the bone is lifted (moving forward and upward).
   • Reduction of splinters . For this procedure, use a nasal dilator and gauze turunda with vaseline oil. In order to correct the splinters, the doctor inserts the dilator into the patient's nasal passage and, gradually pushing its ends, sets the splinters into place. Then, without removing the extender, puts turunda in the nose, securing the result.
   • Complicated fracture with displacement and fragments . First, the fragments are set as described, and then the nose is corrected in one way or another.
4. Straightening a nose that is damaged as a result of a fracture often does not require external fixatives. But sometimes their use is appropriate. For example, when a small fracture fracture bones do not hold and they are fixed by the imposition of gypsum or fixing rollers.

The reposition of the bones of the nose should be trusted by experienced surgeons, especially if more than a week has passed since the moment of fracture. After some time, thanks to qualified help, you can forget about the trauma of the nose. But sometimes, after the edema subsides, the patient observes a deterioration in the appearance of the nose. In this case, the patient is prescribed rhinoplasty, which will eliminate visible defects. With the curvature of the nasal septum septoplasty is performed .

Straighten your nose after a fracture can be both paid and free. Many medical centers offer nasal reposition services. Prices for this service range from 2 to 40 thousand rubles. The final price depends on the complexity of the fracture, methods of examination and the operation, time spent in hospital, the cost of consulting a doctor and so on. Free surgery is carried out in the city municipal hospitals.

Comparative review of prices for reposition in some cities:

• Moscow - from 2500 rubles. (finger), from 5000 rubles. (instrumental);
• Ufa - 2000 rubles. (excluding anesthesia), 3500 rubles. (with fixation on a tampon);
• Tula - from 3000 rubles. (finger) from 5800 rub. (instrumental);
• Ekaterinburg - from 1500 rubles;
• Astana - 4000 tg.

If the preference is given to private clinics, in order to correctly determine the need to pay for certain services, you can read the patient reviews. As a rule, people are more willing to share either negative or positive experiences.