Nasal bone fractures and cartilage injuries can lead to swelling, Punktschmerzhaftigkeit, hypermobility, crepitus, epistaxis and a periorbital hematoma. The diagnosis is made clinically in general. The treatment includes the reduction and the stabilization by internal tamponade and splinting. A septal hematoma is drained immediately.

The nasal bones are fractured by all facial bones because of its central and prominent position most often. Depending on the mechanism of injury and fractures of the maxilla, the orbit, the ethmoid and the lacrimal ducts can be added.

Nasal bone fractures and cartilage injuries can lead to swelling, Punktschmerzhaftigkeit, hypermobility, crepitus, epistaxis and a periorbital hematoma. The diagnosis is made clinically in general. The treatment includes the reduction and the stabilization by internal tamponade and splinting. A septal hematoma is drained immediately. The nasal bones are fractured by all facial bones because of its central and prominent position most often. Depending on the mechanism of injury and fractures of the maxilla, the orbit, the ethmoid and the lacrimal ducts can be added. Complications are cosmetic deformity and functional obstructions. Septumhämatome are subperichondriale accumulation of blood that can lead to avascular or septic cartilage necrosis with subsequent deformation. A fracture of the cribriform plate can result CSF leakage with an increased risk of brain abscess or meningitis. Fortunately, this complication is rare. Symptoms and signs A facial trauma with epistaxis may indicate a nasal fracture. Other signs and symptoms are obvious or subtle Nasendeformierungen, swelling, Punktschmerzhaftigkeit, crepitus and instability. Wounds, bruising may also be present (nasal and periorbital), septal deviation and nasal obstruction. A septal hematoma appears as livid bulge on the septum. A Liquorrhinorrhö appears as a clear discharge, but can also be mixed with blood, which makes the identification difficult. Diagnosis Physical examination The diagnosis is made by physical examination. Simple radiographs of a nasal fracture are not helpful, because their sensitivity and specificity is low. If further fractures or complications suspected, a CT of the facial bones is made. Symptomatic treatment Care For septal hematoma: immediate drainage In malformations: Delayed reduction to immediate treatment is cooled with ice and administered a painkiller. A septal hematoma is immediately incised and drained to prevent infection and cartilage necrosis. A reduction is only required for fractures that left a clinically visible deformity or nasal passage obstruction. The endpoint of reduction is determined by the clinical appearance or airway patency. The reduction is usually moved to 3-5 days after injury to reduce swelling. but it should be done within 2-3 weeks after the injury, before forming bone callus. In adults, the reduction of a nasal fracture can be performed under local anesthesia in children general anesthesia is necessary. Through the nasal cavities a blunt lifting instrument is inserted and placed under the pressed-in nose which is then lifted anterior and laterally, while maintaining a pressure on the other side of the nose is applied to bring the bridge of the nose in the center line. The nose can be stabilized by using an internal tamponade (consisting of antibiotic soaked cotton strip) that is placed high in the nasal vestibule, as well as with an external splint. The internal tamponade remains are 4-7 days, the external splint for 7-14 days. Antibiotic prophylaxis is effective against Staphylococci and is required to reduce the risk of toxic shock syndrome for the duration of nasal packing. Cartilage injuries often require no reduction. In the rare cases of persistent edema reduction after deformation repositioning and splinting under local anesthesia is usually successful. Septumfrakturen are difficult to keep in place and often require a later operation of the septum necessary. Fractures of the ethmoid with a CSF leak must be treated in a hospital with bed rest, increased head position and placement of a lumbar drainage. Dealing with lumbar drainage and antibiotics differs depending on the hospital. When the CSF leak persists, surgical repair of the skull base may be required. Summary The main concerns of nasal fractures are septal hematomas, epistaxis, nasal obstruction, cosmetic problems and the rare Siebbeinplattenfrakturen. Radiographs of the nose are not required. An immediate drainage of septal hematoma is important. The reduction and some other measures can be delayed for 3-5 days so that the edema can resolve.

Health Life Media Team

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