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    The broken nose

    Nasal injury is a common emergency seen by Ear, Nose and Throat surgeons, and is seen in fights, sports trauma and falls.

    Immediately following injury patients often have a nosebleed. The nasal bridge then swells up and the areas on the sides of the nose become bruised. Application of ice at an early stage helps limit the bruising and swelling. The lower, soft part of the nose can be kept pinched for about 10 to 15 minutes to stop the bleeding.


    Although broken noses often show a noticeable deviation immediately following trauma, there may be cases where one of the two nasal bones may be slightly displaced. Assessment of minor degrees of displacement can in some cases only be done a few days after injury when the swelling starts to subside.


    In the immediate situation it is important for the emergency doctor to exclude a ‘septal haematoma’. A septal haematoma means blood clot forming under the nasal lining. It is identified as a soft purplish swelling on both sides of the septum when examining the nose internally. It causes blockage of both nostrils. A septal haematoma should be drained by operation within a few hours otherwise the nasal cartilage would be permanently damaged and may necrose and die.


    If there is no septal haematoma then further management depends on whether the patient is bothered by his or her appearance. Most individuals do not accept a bent nose and opt to have the fractured nasal bones repositioned (‘reduction’ of the fracture). Reduction of the fracture should take place ideally within the first 10-12 days after injury since after this time the bones start to fuse in their new position.


    Reduction of nasal bones in my practice is carried out under a short general anaesthetic and an external splint is applied to keep the bones in position. Patients are discharged after a few hours following recovery from their anaesthetic. The splint stays in place for a few days and helps stabilize the delicate nasal bones while protecting them from further accidental trauma.


    Severe injuries can cause fractures of both nasal bones and cartilage. Simply pushing the bones back in these cases will not get a perfect result since deviated cartilage will eventually deform the nasal shape once again. In such cases a septorhinoplasty would have to be carried out a few weeks later.


    ©Mr. Adrian M Agius

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