Nasal trauma (injury)

Ear Nose | Emergency Medicine | Nasal trauma (injury) (Disease)


Description

Nasal trauma is defined as any injury to the nose or related structure that may result in bleeding, a physical deformity, a decreased ability to breathe normally because of obstruction, or an impaired sense of smell. The injury may be either internal or external.

Fractures resulting from trauma to the nose may involve the bones of the septum (the partition of bone and cartilage dividing the two nostrils) as well as the bones surrounding the eyes. These bones include the nasal, maxilla, lacrimal, and frontal bones. Direct trauma to the bridge of the nose may also result in damage to a part of the base of the skull known as the cribriform plate. This injury in turn may allow cerebrospinal fluid to leak out of the skull and leave the body through the nose. Fractures may also damage the membranes that line the nasal passages, leading to possible formation of scar tissue, obstruction of the airway, and damage the sense of smell.

In addition to fractures, external injuries of the nose include soft-tissue injuries resulting from bites (human and animal), insect stings, cuts, or scrapes. Lastly, nose piercing as a fashion trend is a type of intentional injury to the nose that has several possible complications, including infections of the cartilage and soft tissues in the nose; blockage of the airway due to a loosened stud or other nose ornament; and gastrointestinal emergencies caused by accidental swallowing of nose jewelry.

Causes and Risk factors

Internal injuries to the nose typically occur when a foreign object is placed in the nose or when a person takes in drugs of abuse (inhalants or cocaine) through the nose. External injuries to the nose are usually blunt force injuries related to sports participation, criminal violence, child abuse, or automobile or bicycle accidents. This type of injury may result in a nasal fracture.

The nasal bones are the most frequently fractured facial bones due to their position on the face, and they are the third most common type of bone fracture in general after fractures of the wrist and collarbone. A force of only 30 g is required to break the nasal bones, compared to 70 g for the bones in the jaw and 200 g for the bony ridge above the eyes. The pattern of the fracture depends on the direction of the blow to the nose, whether coming from the front, the side, or above the nose. Although not usually life-threatening by itself, a fractured nose may lead to difficulties in breathing as well as facial disfigurement.

Diagnosis and Treatment

X-rays and other imaging studies are usually unnecessary. However, the doctor may recommend a computerized tomography (CT) scan if the severity of the injuries makes a thorough physical exam impossible or if the doctor suspects other injuries. The doctor may recommend simple self-care measures, such as using ice on the area and taking over-the-counter pain medications. ...