Nasal Injuries

By Natasha ArmstrongYear 11 Mr. Tannous

The Nature of nasal injuries Nasal injuries can result in damage to the skin, bone, cartilage or all three mentioned. Nosebleeds are common and usually settle on their own with simple first aid by gently

pinching the lower half of the nose for 15 minutes. Nasal packing or cautery in hospital is reserved for nosebleeds that do not stop of their own accord.

Most nose bleeds (epistaxis) are not serious. However, some can be quite frightening, and a few are even life-threatening. nosebleeds are classified into two different types.

General facts and types:objects that can get lodged in the nose: Beads Buttons Sweets Nuts Seeds and Peas

Nasal injuries can result in damage to the skin, bone, cartilage or any combination.

If the skin is cut this requires cleaning and then closing using either sutures or self adhesive strips.

Bony fractures of the nose account for nearly 50% of all facial fractures. Fractures to the nasal bones cause a lot of swelling and it may take about five days for the swelling to settle down enough for the bones to be checked.X-rays do not contribute to the clinical management of nasal fractures, as the majority are simple and uncomplicated. Only when more serious injuries have taken place are they important and should include the skull and face.Most of the time when the swelling has settled down and there is either no or little change in the shape of the nose.

nosebleeds are classified into two different types:

Anterior nosebleed: Most nosebleeds begin in the lower anterior part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by being struck in the nose or by the edge of a fingernail or even by sneezing.

Posterior nosebleed: Rarely, a nosebleed can begin high up and deep within the nasal cavity and flow down the back of the mouth and throat even if the patient is sitting or standing. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face. Posterior nosebleeds are often more severe.

Treatment of nosebleeds Keep the person injured calm. If he or

she is upset, the bleeding may become worse. Soak half of a cotton ball with nasal drops, place it in the nostril that is bleeding, and pinch the nose firmly for 10 minutes. Put ice packs on the bridge of nose.

Keep the head elevated. If the nosebleed persists, see your

doctor or go to the nearest emergency room. After the bleeding stops, get an X-ray of Nose and Sinuses to rule out any infection and Foreign body.

Do not strain or bend down to lift anything heavy and Do not blow nose.

Keep head higher than the heart.

What causes nosebleeds? Allergies, infections, or dryness that

cause itching Vigorous nose blowing that ruptures superficial blood vessels in the elderly and in the young.

Picking of the nose, A deviated septum, Hypertension, Bleeding disorders, Fractures of the nose

Rarely, tumours (both malignant and non-malignant) have to be considered, particularly in the older patient

Nasal Injury and Nasal Foreign Bodies: The nasal bones are the most

commonly fractured bones of the face as they occupy a prominent, exposed position and have little structural support. They may be undiagnosed. Changes in appearance and function can be prevented by prompt, appropriate management. Rhinoplasty and septoplasty procedures are often performed to correct untreated fractures.

There is usually evidence of facial trauma.Obvious deformity of the nose may be seen.Other signs may include:

Swelling

Skin lacerations

Crepitus and instability

Bruising  Epistaxis and/or cerebrospinal fluid

(CSF) rhinorrhea; epistaxis implies mucosal disruption which increases suspicion of fracture, includingg possible nasal septum fracture.

Complications… Blood collecting (haematoma) under

the lining (mucosa) of the central partition wall of the nose (septum) is stripped off either side causing a purple swelling inside the nose. If this occurs it will give you nasal obstruction and pain and need treating by draining the blood away soon after it happened.

If the blood is left and not drained it can become infected or cause damage to the underlying support destroying cartilage and then leave a ‘saddle nose’ deformity.

Nasal blockage usually occurs after the injury due to swelling inside the nose and this may take a few days to settle. If the nose is still blocked after three weeks it may be due to the septum being deviated and buckled, which blocks the nasal passage. Septal deviation may require surgical correction if the blockage is significant.

Bibliography [1] http://DisplayConcepts.asp?WordId=CSF RHINORRHOEA&MaxResults=50

[2] St. John Australian first aid page 261-283[3] http://drpaulose.files.wordpress.com/2008/04/nosebleeds [4] http://www.emedicine.com/ent/topic159.htm[5] Logan M, O'Driscoll K, Masterson J; The utility of nasal bone radiographs in nasal trauma.[6] http://www.engtuk.org/patient-info/nose/injuries_html[7] Zargar M, Khaji A, Karbakhsh M, et al; Epidemiology study of facial injuries

By Natasha Armstrong