Injury of nose and foreign bodies in nose

Fracture of the bones of the nose. The upper third of the nose has a bone base, and the lower third and the nasal septum consist of cartilage. With a direct impact on the nose, a fracture of the bones of the nose may occur. Such a patient needs to find out the following: when there was a trauma, whether there had been any injuries to the nose, if there was nosebleeds, whether there is obstruction of the nose, or if there is no discharge from the nose of the cerebrospinal fluid. Ask also, did the victim lose consciousness. Note whether there are fractures of other facial bones (a fracture in the zygomatic bone and upper jaw can cause malocclusion and disrupt the normal opening of the mouth). If there is a rapid development of swelling of injured tissues, diplopia may occur. Carefully palpate the edges of the orbit to exclude "stupae" at their edges. The X-ray image of the facial skeleton is not always informative, as old lesions can be found on the cartilage, and cartilage damage is not detected, and they should, as a rule, be kept in mind for some, though not very specific, forensic reasons.

Swelling of the soft tissues during the first examination of the victim can hide the true deformation of the facial skeleton - in such cases, the patient should be examined again after 5-7 days (especially in children). Reposition of bone fragments is performed under general anesthesia in the first 10-14 days (fractures of the bones of the facial skull usually completely fuse after about 3 weeks). The cheek bone and the upper jaw coalesce quite quickly, and therefore such victims should be immediately consulted by a specialist in maxillofacial surgery. After surgery, the injured are advised to keep the ice in the area of surgery for 12 hours; They should sleep with a raised head, sneeze only through the mouth; they must refrain from blowing and sharp movements. Such patients should undergo a second medical examination 2 weeks and 2 months after the operation. And in a few months, a submucosal resection can be performed about the curvature of the nasal septum.

Rhinorrhea with cerebrospinal fluid. Fractures of the bone in the area of the roof of the maze of the latticed bone can lead to the outflow of the cerebrospinal fluid. In this case, the liquid that has expired from the nose contains glucose (in such cases, the "Clinistixw-test is confirmed by a laboratory test for sugar). Such leakage of the CSF usually ceases by itself, but if this does not happen, then a neurosurgical closure of the opening in the dura mater can be performed. To prevent meningitis in such cases, you should make a swab from the nose with a swab and start treatment with flucloxacillin and ampicillin - both 250 mg every 6 hours inside, without waiting for the patient to "go into intoxication."

Hematoma in the region of the septum of the nose. It can occur after an injury and cause nasal obstruction; With a rhinoscopy, a sharp swelling is seen on both sides of the septum. Blood clots should be immediately removed under local anesthesia through incisions, and antibiotics should be given inside to prevent infection (eg, amoxicillin 250 mg every 8 hours). If the hematoma of the nasal septum is left unattended, there is a risk of necrosis of the cartilage of the nasal septum or "collapsing" of the nose.

Foreign bodies in the nose. Most often they are introduced into the nose by children intentionally. If this is an organic material, then a purulent discharge from the nose appears, inorganic substances can remain in the nose inert for a long time, i.e. Without causing any response from the surrounding tissues. If the child manages to make contact and becomes communicative, sometimes it is possible to grab the foreign body with tweezers and pull it out. You can also use a 2.5% cocaine spray, after which the swelling of the nasal mucosa decreases, allowing you to suck the foreign body from the nose by sucking. If general anesthesia is required, then respiratory protection is necessary.

Causes of perforation of the nasal septum. They are diverse: postoperative (submucous resection), trauma, forced picking in the nose, inhalation of chromium salts, snorting of cocaine, presence of corrosive ulcers (a kind of basiolioma of the nose), malignant granuloma, tuberculosis, syphilis. The area of the perforation of the septum of the nose constantly worries the patient, in this area dry crusts are formed, the ulcer often bleeds. Treatment is symptomatic. Surgical closure of perforation is difficult to defeat.

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