Nasal Trauma PDF

Facial and nasal truma D.SHORASH SINDI  2 zygomatic, 2 nasal, 2 lacrimal, 2 inferior nasal conchae, 2 palatine, 2 maxillae, vomer, mandible introduction & the body if 1 ee For i g NASAL FRACTURES u Relatively little force is required to fracture...

Facial and nasal truma D.SHORASH SINDI  2 zygomatic, 2 nasal, 2 lacrimal, 2 inferior nasal conchae, 2 palatine, 2 maxillae, vomer, mandible introduction & the body if 1 ee For i g NASAL FRACTURES u Relatively little force is required to fracture the nasal bones Most fractures result from laterally applied forces (over 66%),fractures following frontal injuries accounted for 13%,greater force is is required to fracture the nose with a blow directed from the front as the nasal cartilages behave like shock absorbe CAUSES WIFE trauma including accidental personal assaults, sports injury and RTA (road traffic accident) domestic violence. Falls (common in children) Falls from syncope or impaired balance in the elderly Nasal fractures - classification u i_f Class 1 - frontal or frontolateral trauma- vertical septal fracture- depressed or displaced distal part of nasal bones face u Class 2 - lateral trauma- horizontal or C-shaped septal fracture- bony or cartilaginous septum fracture- frontal process of maxilla fracture u Class 3 - high velocity trauma- fracture extends to ethmoid labyrinth- bony septum rotates posteriorly- bridge collapse- upturned tip, e revealing nostrils- depressed nasal bones pushed up under frontal bones- apparent inter-ocular space widening(telecanthanus) Clinical presentation History: A detailed history should include the following: Mechanism of trauma: What was the direction of the force and the nature of the striking object? IWas there associated epistaxis at the time of the trauma?stops spontaneously History of previous facial trauma or surgery Other than swelling, is the nasal appearance different from before the trauma? Does the patient perceive a functional impairment in breathing compared to before the trauma? If so, which nostril is impaired? Is the nasal fracture related to an assault or motor vehicle accident? If so, there may be medical–legal aspects to address u Symptoms and Physical Examination: These can include the following: 1.Epistaxis 2.Edema 3.Nasal obstruction 4.Ecchymosis 5.Subconjunctival hemorrhage 6.Olfactory disorders: Suspect injury to the cribriform plate if anosmia exists. 7.Crepitus 8.Obvious nasal deformity 9.Depression or concavity of the nasal bones 10. Mucosal lacerations 11. A bluish or reddish fluctuant swelling along the septal wall may suggest a hematoma Investigation we EE o u 1-Plane x ray is controversial,not required to make the diagnosis No benifit, just done for medicolegal issues 2-ultrasound o u u 3-CT scan Management u fracture Nothing if no deformity. Reassure and review u Class 1- reduce if early - disimpact and realign - if swollen, manipulate and reduce at 5-7 days u fracture Class 2- septal fracture is often overlapping so fractures redisplace - manipulation of the nasal bones should follow excision of overlapping edges Manipulation should not be delayed more than 10 to 14 days as fracture(s) become “sticky” and fixed, making reduction difficult or impossible. It is also inappropriate to try to reduce an old deformity as the attempt will rarely succeed u - fracture Class 3- requires open reduction - depressed nasal bones need elevation and support - septum is approached intranasally and reduced antero-inferiorly - malunion will require formal septorhinoplasty at 4-6 months if requested Surgical Instruments for Reduction of Nasal Bone # F External nasal splints of To Septal haematoma. This is due to a collection of blood beneath the mucoperichondrium of the nasal septum. It may follow nasal trauma, ,as a complication of septal surgery rarely, blood dyscrasias. C/P: complete bilateral nasal obstruction a septal abscess,cartilage necrosis and nasal saddle deformity may ensue. R:Aspiration may suffice if the haematoma is small, but incision and drainage with quilt suturing. antibiotics to reduce the risk of local and systemic Septal haematoma Thank you