Bruised nose
definition
In the event of a bruise (Contusion lat. Contusio) in the nasal area is the result of a blunt direct force of force on bony, cartilaginous tissue, as well as the skin and mucous membrane. In the case of a nasal contusion, the damaged tissue is connective tissue and fatty tissue. The physical impact rarely results in a defect in the skin, but only in the layers below. The contusion must be clearly distinguished from a fracture, as this results in different need for action. The nasal bruise is therefore a diagnosis of exclusion, since after excluding a nasal bone fracture, the result is a nasal bruise.
causes
Blunt external violence can usually be traced back to a willful or unforeseeable event. The bruised nose is most often caused by a traffic accident, falls of any origin, sports accidents (e.g. martial arts) or violence by third parties. It is important here that only a direct effect on the tissue also leads to a bruise.
Concomitant symptoms
Particularly noteworthy are the typical signs of inflammation during a contusion. This is a painful swelling that can appear overheated and reddened due to excessive blood flow to the nasal area. The consequence of this is a functional restriction due to the swelling, which means that nasal breathing can only be painful.
In addition to the signs of inflammation, nosebleeds (Epistaxis) and / or a hematoma as a result of vascular or capillary injuries. Experience has shown that nosebleeds return after a short time. The swelling that makes breathing difficult through the nose, as well as the pain that occurs, can force mouth breathing. As a result, it is possible that painful breathing may lead to respiratory care, which in rare cases can lead to pneumonia due to insufficient ventilation of certain lung areas.
Read more about this under Epistaxis - What To Do?
Depending on the cause of the injury, headaches can also occur.
The symptoms of a bruise greatly overlap with those of a fracture. Therefore, if possible, a clear diagnosis should always be made by a doctor.
a headache
A bruise headache can have different causes. In particular, the nose should be mentioned as a source of pain. The headache caused purely by the soft tissue defects of the nose can be as rhinogenic headache are designated. But it can also be a transferred pain (Referred pain) occur in the area of the face and nose, which can then lead to a perceived headache. This means that the unification of sensitive nerve cords in the area of the nose with the cords of other regions of the head, which are actually responsible for the headache, is what creates the pain experience. Orthopedic causes are also to be named as sources, which arose in the accompaniment of external violence and then need to be further clarified.
Epistaxis
That as Epistaxis A symptom of a discharge of blood from the nose, known in the clinic, is a common side effect of a bruised nose. It is typical that the epistaxis subsides again after a short time. The reason for this is the good blood circulation in the nasal mucosa, especially in the area of the Locus Kiesselbachi, which sits in the front lower third of the nasal mucosa. In the event of violence, the smallest vessels can be injured and cause blood to escape.
If the bleeding does not stop, a therapeutic measure using tamponade or sclerotherapy of the blood vessel is necessary.
Read more about this under How can you stop nosebleeds?
swelling
The inflammation sign of the swelling is caused by tissue mediators (tissue-active substances). The reaction is part of the healing process, but is usually found to be uncomfortable to painful. The swelling is characterized by increased blood flow, so that tissue can be repaired with the help of flooded blood components. Since it is a benign space-occupying process, softer or missing facial contours can be seen in the area of the nose. In principle, the increased tissue pressure is not harmful. However, care should be taken not to pinch off or squeeze other nearby tissues.
diagnosis
By anamnesis (Patient survey) the cause of the injury is clarified and can be clarified more precisely through a palpation examination. If a more serious finding is suspected, the injury can be shown and localized more precisely using imaging methods. These procedures are mostly classic x-rays, computed tomography (x-ray slices), or magnetic resonance tomography.
Since an injury can also be a fracture (broken bone), this finding must first be ruled out in order to be able to rule out drastic consequences. A bruise is therefore always an exclusion diagnosis that can be safely ruled out using the procedures listed.
Read more about this under
- MRI of the head
- MRI Or CT - What's the Difference?
How do I tell the difference between a bruised nose and a broken nose?
A reliable differentiation can only be made by means of an X-ray image. The radiation shows whether there is a fracture in the nasal bone (nose bone). However, a first impression can be obtained by means of an external inspection before the X-ray is taken. If the nose is inclined, this is already a strong indication of a broken nose. In the context of the sharp-edged tears in this case, a pronounced regional hematoma can occur, which is caused by damage to the surrounding capillaries. A rubbing, grinding noise can also be heard and felt due to mechanical interactions between the broken edges.
If there is a suspicion of a more serious defect in structures around the nose, more complex methods such as computed tomography or magnetic resonance tomography should be used to enable a more precise assessment. In the event of a negative finding after excluding a bony fracture, the diagnosis of contusion can be made as a diagnosis of exclusion. Magnetic resonance imaging, which is sensitive to soft tissue, can represent a further diagnostic step after considering the cost-benefit ratio.
Read more about this under Symptoms of a broken nose
Treatment / therapy
Both conservative and drug therapies are possible as a diagnosis of exclusion (i.e. after a nasal fracture has been reliably ruled out).
The non-drug therapy forms include, for example, cold applications (e.g. 3x 10 min per day) in the area of the bruise. This allows inflammation to be limited and pain relief. Immobilization, light compression, and holding up the body part are also possible, but can only be implemented to a limited extent in the area of the nose.
Classic painkillers should be administered at the same time. The drugs displayed here are non-steroidal anti-inflammatory drugs (also known as COX inhibitors), which, in addition to their analgesic effect, also have an anti-inflammatory effect and thus increase the patient's well-being in both cases. These include ASA, ibuprofen and diclofenac, as well as paracetamol (separate drug group). However, because of their side effects, these drugs should be carefully weighed in each patient with the advice of a doctor. The drugs facilitate the healing process, but do not speed it up.
Read more about this under NSAIDs
If the tissue damage is irreparable, surgical intervention may be necessary. Is there an extensive bruise in the area of the bruise (Hematoma), depending on the tissue pressure and size, hematoma removal can be discussed.
Healing time
The healing time is a very flexible time specification, which, however, correlates with the extent of the tissue damage, the presence of a hematoma, the general condition and nutritional condition of the patient, as well as other factors. Avoiding strong to moderate sun exposure can have a positive effect on the healing process. The healing time may vary depending on the patient's compliance with the restraint, the use of cold and the use of anti-inflammatory medication. Roughly, a period of one week for a mild bruise up to 2-3 weeks for a moderate injury can be assumed. If it is a serious injury with possible scarring under the closed skin layer, the healing process can sometimes take a month.
