Broken nose
Synonyms in a broader sense
Broken nose, broken nose, nasal fracture
English: nasal bone fracture, fracture of the nose bone, fracture of the nasal bone
Definition of a broken nose
About one third of the human nose consists of bones, the lower two thirds including the tip of the nose are made up of cartilage. As a part of the body that protrudes more or less clearly from the face, the nose is particularly at risk of being damaged by external violence.
The nasal bone fracture belongs to the central midface fractures and is defined as a closed or open fracture of the nasal bone (os nasale), whereby the nasal septum is often also affected. As a rule, the nasal bone fracture results from a blunt force on the nose.
Read more on this topic: Pain in and around the nasal bone
frequency
Of the Broken nose is a comparatively common injury. However, their incidence has decreased significantly in recent years, which is mainly due to the fact that the safety systems of cars are constantly being improved and broken noses are therefore less common in accidents. Men are affected somewhat more often because they tend to be more affected by accidents in the context of extreme sports and acts of violence.
Illustration of a broken nose
Broken nose
(also nasal bone fracture, broken nose)
- Upper jaw, frontal process -
Maxilla, frontal process - Nasal bone - Nasal bone
- Frontal bone - Frontal bone
- Eye socket - Orbit
- Nasal cartilage (hot blue) -
Cartilagines nasi - Ethmoid, perpendicular plate -
Ethmoid bone,
Perpendicular lamina - Tearbone - Lacrimal bone
- Atrium of the nasal cavity -
Nasal vestibule - Upper jaw - Maxilla
- Zygomatic bone - Os zygomaticum
You can find an overview of all Dr-Gumpert images at: medical illustrations
causes
Any form of violence to the nose can cause one Broken nose cause. The breaks particularly often nosewhen subjected to so-called blunt force from a shock, blow or fall. The risk of this is particularly high in accidents in traffic or at work, but injuries during sports or a fight can also lead to breakage.
Clinically, the fracture of the nasal bone is particularly noticeable due to the inclined position of the nose. If the force hits the nose from the side, one often finds a more or less large indentation on the opposite side wall of the nose. A force from the front causes the entire outer nose to widen. In this case, the nasal bone usually breaks across in the lower third, and the cartilaginous nasal septum is usually also broken.
Usually, a broken nose is accompanied by severe nosebleeds and bleeding under the skin, which can be seen as discoloration (bruises, bruises) become visible (these hematomas often occur in the area of the septum). Because of the hematoma, swelling of the nose often follows.
Furthermore, nasal breathing may deteriorate, smell impairment and, more rarely, crepitation (an audible and palpable crackling noise that occurs when broken nasal bone is caused by the movement of broken bones). When fragments of bones move, this is usually very clear: depending on the position in the form of a sunken bridge of the nose or a deviation of the nose to the side (because this type of injury often occurs in boxing, one often speaks of a "boxer's nose"). Sometimes the change in shape, if it is only slight, is initially hidden by the swelling of the nose.
After a very strong impact, neighboring bone elements of the nasal bone can also be broken. Due to their location, the frontal process of the upper jawbone, the ethmoid bone (Ethmoid bone) and the tear bone.
Symptoms that result from a bending of the nasal septum are actually only noticeable some time after the fracture and are therefore often not associated with the event of the injury. These include, among other things, the increased susceptibility to inflammation in the areas of the throat, middle ear and paranasal sinuses. In addition, patients are more prone to nosebleeds and snoring than healthy people.
The most noticeable acute symptoms of the nasal bone fracture are the hematoma discoloration and any lacerations that may be present, whereby one must be careful, as these two seem more extreme in contrast to the change in shape of the nose, but are not proof of an actual fracture.
Most often, the fracture of the nasal bone gives the patient a lot of pain.
Read more on the topic:
- Broken nose symptoms
- Bruised nose
- Inflammation of the periosteum of the nose
diagnosis
When a Change in shape of the nose there is no longer any doubt about a broken nose. Otherwise the diagnosis is based on a X-ray image posed. This also records the exact location of the fracture gap and shows any displacements of the individual bone fragments. About non-bony structures, such as this Nasal septumTo be able to assess, is an inspection of the inside of the nose (technical term: Rhinoscopy) necessary. By carefully feeling the nose (palpation), broken edges of bones can be felt or the mobility of individual pieces of bone can be determined.
If there is a suspicion of accompanying injuries in the Area of the eye socket, of the Skull base or other bones, in addition to the x-rays, you should have one Computed Tomography (CT) or a Magnetic resonance imaging (MRI).
Detect a broken nose
In the case of a broken nose, a distinction must be made between open and closed fractures.
Since bone fragments penetrate the surface of the skin in the presence of an open nasal bone fracture, this type of fracture is usually quite easy to recognize.
However, recognizing a closed nasal fracture is much more difficult.
In the presence of a closed nasal bone fracture, a significant deformation of the nasal framework is not always visible.
In most cases, the fracture only shows itself in the course and is therefore often more difficult to detect.
Nevertheless, the appearance of typical symptoms can indicate a broken nose and make it easier to identify the fracture.
Typical symptoms of a fracture of the nasal framework are bleeding from the nose and swelling of the tissue surrounding the nose.
Most of the patients affected by a broken nasal bone complain of severe pain in the midface area. These pains often take on a pulsating character and persist for a long period of time.
In addition, the pain characteristic of a broken nose can be exacerbated by touching it lightly or touching it. In most cases, these pain symptoms also significantly limit speaking and the use of the facial muscles.
Furthermore, the presence of a nasal bone fracture can often also be recognized by visible abrasions and / or lacerations in the area of the nose. Bruising (Hematomas) can be observed in the affected patient both directly on the nose and in the area of the cheekbones and / or the eye sockets.
As a rule, the violent forces that lead to the formation of a nasal bone fracture cause significant swelling of the inside of the nose.
For this reason, a broken nasal bone can often be recognized by a restriction in nasal breathing.
In addition, the sense of smell is often negatively affected by damage to the nasal framework. In many of the affected patients, the presence of a fracture of the nasal bone can be seen optically through a clear deformity of the nasal framework.
In this context, there is usually a lateral deviation of the bridge of the nose to one of the two halves of the face. The appearance of a visibly dented bridge of the nose is also not uncommon in the case of a broken nose. Furthermore, a fracture of the
Classically recognize the nose by the fact that the entire nose or the nasal framework is much more flexible.
Due to the very clear symptoms, the nasal fracture can be recognized relatively quickly and reliably in everyday clinical practice (Eye diagnosis).
Above all, the visible deformation and the formation of bone steps help the doctor to recognize the broken nose as such.
Nevertheless, a radiological examination should be arranged. Only in this way can the extent of the nasal fracture be estimated and further fractures excluded.
Nasal fracture therapy
The treatment of a nasal bone fracture is divided into surgical and non-operative (conservative) measures. The choice of the appropriate form of treatment depends on the condition of the bony structures and the Extent of soft tissue injury. If the individual fracture fragments are not or only slightly displaced, it is usually sufficient from the nasal fracture The help of a plaster cast or a rail.
After about two weeks, the stability of the bony nose is restored to such an extent that the Treatment as complete applies. In the case of an unstable and / or strongly displaced nasal fracture, the treatment must go through surgical reduction respectively. Surgical correction of the nasal bone should ideally within one day of the accident respectively. The aim of the treatment is to restore the original position of the nasal bone and the Subsequent bone fragments to keep stable.
The operative treatment in the presence of a nasal bone fracture can in principle both under local anesthesia, as well as in general anesthetic be performed. As a rule, the individual fragments are brought into their original position starting from the inside of the nose (access through the nostrils). In the majority of those affected, however, it is also necessary to make a small incision on the inside of the nose. In this way, especially fragile fractures with several small pieces of bone can be easily repositioned and fixed.
Since it is possible with a broken nose that parts of the Nasal septum more extensive surgical treatment may be necessary. To stabilize the nasal septum, they are usually small Plastic foils placed in the nose and fixed there. The more can Bruising removed during treatment. This measure has the advantage of reducing the risk of developing
- Tissue necrosis
- inflammatory processes and
- Infections
In addition, it can be seen in everyday clinical practice that the Cartilage structures of the nose After clearing a broken nose, a plaster cast or one rail be created. In order to avoid bleeding in the area of the cuts, a nasal packing can also be inserted into both nostrils. This tamponade is usually on the first day removed after the operation.
Operation of a broken nose
A broken nose can occur in many cases without surgery be treated (conservative therapy).
In the case of a particularly unstable fracture of the nasal bone and the presence of displaced fragments, however, an operation usually has to be performed.
Only with the help of a surgical treatment can the normal position of the bone fragments be restored and the nasal framework stabilized. In principle, the operation can be used to treat a broken nose local anesthesia be performed.
In many cases, however, the reconstructions to be carried out are so extensive that a nasal bone fracture operation is not necessary general anesthetic is preferred. A blood sample should be drawn prior to performing the surgical procedure. This measure serves to reduce the Ability to clot of the patient to check and understand whether an intraoperative Transfusion might be necessary.
Following the preparatory measures, an informative discussion will be held with the responsible anesthetist.
General anesthesia is initiated immediately before the nasal fracture operation. In the case of surgical treatment of the bony nose, ordinary ventilation can be used Intubation it can be carried out via the oral cavity. During the operation, the individual bone fragments are brought back into their normal position via small surgical incisions within the nose and the natural shape of the nose is restored.
Normally, no scars are visible even after a nasal fracture operation.
In individual cases, however, an incision must also be made below the nasal bridge. This procedure enables the skin covering the nose to be turned back and thus a better view of the nasal framework to be operated on. If the nasal septum is broken in addition to the bony nasal framework, it must be straightened.
This is usually done by inserting and fixing two flexible plastic films.
An incorrect straightening of the nasal septum can lead to severe restrictions in nasal breathing and require further operations.
If there is also a bruise (Hematoma) should have formed, this must be removed. Otherwise, the hematoma can destroy and develop tissue inflammatory processes come.
The consequence is a significant limitation of the Wound healing and an extension of the healing time.
Following the nasal fracture operation, the bone fragments must be stabilized with a plaster cast or a special splint.
In addition, a tamponade is usually inserted into the nose for at least one night. Often, in the course of the nasal fracture, surrounding structures are impaired.
If this is the case, measures that go beyond the normal course of a nasal fracture operation must be taken.
The occurrence of intraoperative complications (for example bleeding) can make an expansion of the usual surgical technique necessary. There are usually strong symptoms within the first week after the operation Swelling in the area of the operation area.
Which, however, can be quickly brought under control through careful cooling.
Complications can arise during the nasal fracture operation.
The most common complications include injuries to the smallest nerve fibers that lead to a limited sensitivity being able to lead. In most cases, however, the compromised nerves recover within a period of a few months.
Cutting through larger nerve fibers can lead to Signs of paralysis and create the feeling of temperature fluctuations.
In addition, after performing a nasal fracture operation, there is a risk of infections and inflammatory processes developing in the area of the operation.
The surgical incisions made during the nasal fracture operation are in most cases with self-dissolving seams provided. For this reason it is not necessary to remove the sutures. The self-dissolving threads dissolve completely within a period of about six months.
Mask for a broken nose
In many contact and ball sports, in particular, accidents involving a broken nose occur again and again. Some athletes (especially soccer) suffer nasal fractures several times during their careers. This can not only lead to medical problems, but also have aesthetic consequences. Besides the risk of Narrowing of the nostrils and the resulting obstructed airway, it often becomes unsightly after multiple nasal fractures Deformations of the nose. These may need to be corrected by a plastic surgeon.
In order to protect the nasal bone from strong forces during exercise, a so-called Nasal mask be applied. Especially in the period immediately after the surgical treatment of a broken nose, the bony nose must be spared. Wearing a mask in the case of a broken nose is particularly useful during this time. Such a mask will individually on the face adapted to the respective athlete.
For this purpose a Plaster cast of the nose and cheek region be made. A suitable mask for a broken nasal bone can then be made on the basis of this plaster cast. The production of a mask after a broken nose is possible in most orthopedic shops. Depending on the material chosen, the cost of such a protective mask differs. The particularly stable carbon masks are usually the most expensive. However, cheaper variants are also available. On average, the price of a mask after a broken nose is between 100 and 500 euros.
Statutory and private health insurances will in most cases cover the cost of a mask for a broken nose not wornas it is not a medically necessary measure acts. For this reason, the patient is usually forced to bear the costs themselves.
Broken nose in baby
In babies or toddlers, too, strong forces exerted on the bony nasal framework can lead to a broken nose.
Especially while playing or falling from a small height (for example when trying to walk for the first time) the nose can be affected. Parents of affected children usually recognize a broken nose in the baby by its occurrence heavy bleeding from the nostril (nosebleeds).
If there is a broken nose, the nosebleed can usually hardly be stopped. In addition, the broken nose causes severe pain in the baby. Affected children begin to cry after the trauma and cannot be comforted for a long period of time.
Due to the impairment of the bony nasal framework, severe swellings also develop, which make the nose look misshapen.
Another typical symptom of a broken nose in babies is how it develops bruises (Hematoma). These show up just a few hours after the causal event, especially in the area of the bridge of the nose.
Depending on the course of the accident, both a closed and an open nasal fracture can be caused. In most cases, the open nasal fracture is easier to diagnose than the closed fracture. In babies, the open fracture of the nasal bone shows when the skin surface is pierced by tiny fragments of bone.
A baby with evidence of a broken nose must be presented to a pediatrician immediately. The actual diagnosis is made via a clinical examination and the preparation of a X-ray.
If a suitable treatment is initiated promptly, consequential damage is not to be expected even if the baby has a broken nose.
Broken nose in a child
A broken nose is treated in the same way in a child as in an adult. Comprehensive diagnostics must also be carried out on children before choosing the appropriate therapy. Next to the Anamnesis interview and the physical exam become X-rays made of the bony nose. To carry out a Computed Tomography (short: CT) is due to the high radiation exposure often omitted in a child.
In the case of accidents involving a child in general and in the case of a broken nose in particular, the Circulatory situation urgently stabilized become. In addition, it often happens after accidents that lead to a broken nose heavy bleeding. In order to prevent excessive blood loss, hemostasis must therefore be started immediately after the accident. For this purpose are especially suitable cold editionsthat are placed on the neck and on the forehead.
During the Hemostasis should the child sit upright and tilt your head slightly towards your neck. If the nosebleed is severe, tamponades can also be inserted into the nostrils. With a child in particular, it is difficult to assess the end result after the treatment of the broken nose. As in adults, swelling that persists over a long period of time can mean that the treatment result can only be assessed after months.
In addition, it should be noted that the bony nose of a child is usually still growing and the appearance of the nose can therefore change significantly. Despite surgical repositioning, deformations can occur along the fracture lines during growth. However, this risk usually only exists in the case of a complicated nasal fracture (for example in the case of a Comminuted fracture).
Broken nose for pain and suffering
The development of a nasal fracture is in many cases related to active arguments. If a patient is drawn into a one-sided non-verbal argument and injured by the attacker in such a way that a nasal bone fracture occurs, he can various legal steps initiate. It is important for the victim that if there is a broken nose, they are usually entitled to compensation for pain and suffering.
The actual amount of compensation for pain and suffering in the event of a broken nose depends on the extent of the injury (are In addition to the bone fracture, also soft tissue injuries available? Was the eye impaired?), The disadvantages caused by the broken nose (for example Loss of earnings for the self-employed) and the consequences of surgical or conservative therapy (scarring, etc.).
With a broken nose, the heals completely without scars, the person concerned can receive compensation in the amount of 950 to 1000 Calculate euros. At Noticeable scars remain or other restrictions, the entitlement to may increase several thousand euros on. Compensation for pain and suffering after a broken nose does not necessarily have to be sued in criminal proceedings.
In addition, the existence of a criminal complaint has no influence on the Amount of compensation for pain and suffering. In most cases, lawyers advise the perpetrator to be asked in advance to pay an appropriate amount of compensation for pain and suffering and to point out that a payment can be considered in a possible criminal hearing to mitigate the penalty. Those affected should make sure that the payment of compensation for pain and suffering after a broken nose Limitation period of three years from the commission of the offense Has.
prophylaxis
There is actually nothing you can do to prevent a broken nose, except to be careful in everyday life. Above all, this includes appropriate, defensive behavior in road traffic, with the car manufacturers also making a major contribution to the prevention of injuries in general through well-designed safety systems. In addition, you should of course avoid getting into a fight or exposing yourself to unnecessary dangers, for example in certain sports. And if this risk is taken anyway, value should at least be placed on good protective clothing.
forecast
The prognosis depends on the type of fracture (Broken nose) is generally cheap. If there is no misalignment of bone elements, the nasal fracture usually heals completely without causing permanent damage. Even with a break with Bone displacements There is a very good chance that the nose will look exactly the same after repositioning as it did before the injury, if this takes place within ten days at the latest. If the reduction of the bone fragments is not carried out or is carried out too late, it is possible that formal defects such as a Crooked or saddle nose remain. Most of the time these are cosmetic problems only, but in some cases they can be permanent Difficulty breathing through the nose go along (broken nose)
If the nasal septum was also affected by the break and a displacement persists, this can develop in later life Sinus infections, Sore throat, Epistaxis or snoring favor (broken nose).
Exercise for a broken nose
The broken nose is a typical one Sports injury.
In addition to any kind of martial arts, football players in particular often suffer from fractures of the bony nasal framework. Since the considerable force exerted during sport in most cases leads to complicated nasal fractures with several fragments or to the occurrence of displaced fracture ends, surgical treatment is usually required.
After completing the nasal fracture treatment, exercise should be continued for at least six weeks waived become.
Only after this period can one assume that the broken nasal bone has healed and the stability of the bony nasal framework is restored. If you do sport during this period and the nose is affected again, this can lead to a complicated second fracture to lead.
Even after the healing period, certain sports (especially martial arts and soccer) can only be carried out for a further six months with appropriate protection. A special mask, for example, can be worn to protect the bony nasal framework from breaking the nose again.
