Nose – Sinus – Facial Fractures – Trauma

Nasal trauma is an injury to the nose or the areas that surround and support the nose. Internal or external injuries can cause nasal trauma.

The position of the nose makes the nasal bones, cartilage, and soft tissue vulnerable to external injuries. Nasal fractures are the most common types of facial fractures; it can be obvious that there is an injury to the nose due to bruising, swelling, and bleeding from the nose, however, they are often unrecognized and untreated at the time of injury and a careful examination is important for anyone who sustains nasal trauma. Bleeding, swelling, blood clots, and fractures can result from injuries to the nasal area. Physical deformity, infections, and obstructed breathing are potential complications of nasal trauma.

Nasal trauma that results in nosebleeds occurs because the nose has many blood vessels positioned close to the surface. This makes them easy to injure.

The nasal sinuses are usually lined with paper-thin bone and thus have a high tendency to sustain a fracture during trauma. Sinus fractures can lead to a lifetime of sinus disease. As such, sinus issues should be treated by a facial plastic surgeon that has extensive training in sinus surgery as an otolaryngologist (ENT).

Diagnosis

There are several signs and symptoms of a broken nose such as bruising and swelling, bleeding, a crooked misshapen appearance. X-rays and other imaging studies are usually unnecessary. However, your doctor may recommend a computerized tomography (CT) scan if the severity of your injuries makes a thorough physical exam impossible or if your doctor suspects you may have other injuries.
Signs of sinus fracture vary according to the location of the affected sinus.

Fractures of the maxillary sinuses are usually coupled with cheekbone fractures. In cases of isolated maxillary sinus fractures, you may notice air under the skin of the cheek or notice bleeding during nose blowing. However, isolated maxillary sinus fractures can easily go undiagnosed, as very few symptoms are associated with them.

Fractures of the ethmoid sinus are almost always associated with an orbital blowout fracture (a fracture of one or more of the bones surrounding the eye) and would be diagnosed and treated accordingly.

When a fracture involves the frontal sinus, you may notice a depression of the forehead. There may also be some bleeding from the nose. If the fracture involves the back wall of the frontal sinus it may cause leakage of the fluid surrounding the brain, cerebral spinal fluid (CSF). This usually manifests as a clear runny nose that worsens with squatting. It may also feel like salt water is trickling down the back of the throat.

If you think you have a sinus fracture then you should see a specialist to confirm the diagnosis. This is typically done with a CT scan of the head and can determine if there was any damage to the surrounding structures.

Treatment

Treatment depends on the type of injury you have.

Nasal Fracture

If you have a minor fracture your doctor may recommend simple measures, such as using ice on the area and taking over-the-counter pain medications.

If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them. This is usually successful if done within two weeks from when the fracture occurred, preferably sooner.

An injection or nasal spray is used to ease discomfort and your physician uses special instruments to help realign your broken bones and cartilage

Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You’ll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose.

Surgery

Manual realignment may not be appropriate for severe breaks or breaks that have gone untreated for more than 14 days and surgery may be necessary to realign the bones and reshape your nose. If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis.

Sinus Fractures

Ethmoid sinus fractures are typically not repaired. If any repair is needed, it is done in conjunction with an orbital blow out fracture repair.

Similarly, maxillary sinus fractures may also not require repair. This is especially true if fractured pieces of bone are not displaced. However, in cases of severe displacement, repair is required. In these instances repair can be performed through a small incision on the inside of the gum line. The fractured bones are then placed back into their original locations and secured with thin titanium plates.

Frontal sinus fractures will always require intervention. If the fracture does not involve the drainage pathway of the sinus and brain, then simple routine follow up with repeated CT scans are all that is required. However, if the fracture involves the drainage pathway or has caused CSF leakage, the fracture will need to be surgically reduced and plated.

First, the doctor will control your nosebleed (if you have one). If there is a collection of blood inside your nose, called a septal hematoma, the doctor will drain it by cutting a hole in it to let the blood out.

Because your nose will be very swollen at first, a broken nose is not immediately put back into place. Even after the swelling goes down, putting a broken nose back in place is necessary only if you will have a poor cosmetic result or your airflow is obstructed. If it is necessary, a specialist will do it at a follow-up appointment. By this time, the swelling should have gone down, and specialist will be able to put the bone in place more accurately.

Fractures of the bones inside your nose (ethmoid fractures) require hospitalization.

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