Appearance of the nose before reduction of the fracture
Nasal elevator is inserted into the nose to reduce the
A nasal cast using a Murphy's splint is applied
One of the most common fractures in the head and neck is
a broken nose or nasal fracture. The nasal skeleton is made up of
approximately 50% cartilage. Diagnosis is primarily made on
physical exam. This use of "nasal films" is controversial since
plain films will not show a cartilage fracture and if the nasal bones
appear non-displaced on physical exam one does not need to set the nose.
Ideally, a nasal fracture should be set within 7 to 10 days in an adult
and 5 to 7 days in a child, otherwise healing may prevent an optimal
reduction. For optimal reduction, it may be necessary to wait 3 to
4 days until the swelling subsides.
Of importance is to rule out a nasal
septal hematoma. If a septal hematoma is not identified and
drained within 24 hours, the nasal septal cartilage may die. This
can result in a saddle nose deformity.
Fracture of the nasal cartilage usually produces a greenstick deformity which usually cannot be pushed back into place, since
the cartilage retains a memory of the fracture and will slowly deviate
back. To obtain an adequate reduction an open reduction may
have to be performed. Mucosal flaps are elevated off the septal
cartilage and bone. The greenstick fractures are completed to mobilize
the fragments and the displaced, non-supporting fragments are removed.
A nasal fracture is defined as "open" if the nasal bones
are exposed to the outside by a cut or tear in the skin or lining of the
nose. The procedure used to set the fracture is defined as "open"
if cuts in the skin or nasal mucosa are made which allow insertion of
instruments to set the nose or provides direct visualization of the fracture.
If the nose is set by pressure applied to the skin or with instruments
placed into the nasal cavity, the reduction is defined as "closed".
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