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Fractures of the Nose
The bones of the nose are broken more often than any other facial bone. When nasal bones break, the mucous membrane lining the nose can tear, resulting in a nosebleed. Commonly, the bridge of the nose is pushed to one side. Sometimes the cartilage of the nasal septum (the rubbery tissue that divides the nasal cavity into two) can be pushed to one side. If blood collects under the mucous membrane that lines the cartilage of the nasal septum (called septal hematoma), the cartilage may die. The dead cartilage may disintegrate, causing the bridge of the nose to sag in the middle (called saddle nose deformity).
Sometimes when a nose is broken, the bones that join the nose to the skull are damaged. This damage allows the fluid that surrounds the brain and spinal cord (cerebrospinal fluid) to leak out. This damage can also allow bacteria from the nose to enter the space around the brain and spinal cord and cause a serious infection (meningitis).
Medical attention is needed so that doctors can find septal hematomas, cerebrospinal fluid leaks, and other facial injuries that may need to be treated right away.
Ordinarily, a doctor diagnoses a broken nose by gently feeling the bridge of the nose for irregularities in shape and alignment, unusual movement of bones, the rough sensation of broken bones moving against one another, and tenderness. X-rays of the nose are not normally done because they are not accurate for diagnosing fractures or helpful in indicating what treatment is necessary. If doctors suspect an injury to other bones in the face or to the skull, they do computed tomography (CT).
Applying ice packs (every 2 hours for 15 minutes at a time if possible) for about 2 days, taking pain relievers (such as acetaminophen), and sleeping with the head elevated help limit pain and swelling.
Septal hematomas are drained as soon as possible. Blood must be removed to prevent the destruction of the cartilage. The fracture itself can wait. Doctors usually wait 3 to 5 days after an injury for the swelling to go down before they push the broken pieces of bone back into place (called reduction). Waiting makes it easier for doctors to see and feel when the pieces are perfectly aligned. Many nasal fractures are in a good position and do not have to be reduced.
First, doctors give adults a local anesthetic, which numbs the area. Children are given a general anesthetic, which causes temporary unconsciousness. By pressing with their fingers and lifting with an instrument inserted into the nose, doctors manipulate the bones into their normal position. The nose is then stabilized with an external splint. Doctors may need to insert gauze into the nose too (internal packing). Antibiotics are given while the packing is in place to decrease the risk of infection. Nasal bone fractures heal in about 6 weeks.
A person with leakage of cerebrospinal fluid is admitted to the hospital, and a drain is inserted near the spinal cord in the lower back (lumbar drain).
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