Nasal trauma and foreign bodies in the nose

Nasal bone fracture. The upper third of the nose is made of bone, while the lower third and the septum are made of cartilage. A direct blow to the nose may cause a fracture of the nasal bones. The following information should be provided to the patient: when the injury occurred, whether there were previous injuries to the nose, whether there was a nosebleed, whether there is nasal obstruction, whether there is cerebrospinal fluid leakage from the nose. Also ask if the patient has lost consciousness. Note whether there are any fractures of other facial bones (a fracture in the zygomatic bone and maxilla may cause malocclusion and disrupt normal mouth opening). If there is rapid swelling of the injured tissues, diplopia may occur. Carefully palpate the orbital margins to exclude “steps” along their edges. X-rays of the facial skeleton are not always informative, since they may reveal old lesions, while cartilage lesions are not detected, but they should usually be kept in mind for some, although not very specific, forensic reasons.

Soft tissue swelling at the first examination of the victim may conceal a true deformation of the facial skeleton - in such cases, the patient should be re-examined after 5-7 days (this is especially true for children). Reposition of bone fragments is performed under general anesthesia in the first 10-14 days (fractures of the facial bones usually completely heal in about 3 weeks). The zygomatic bone and maxilla heal quite quickly, and therefore such victims should be immediately consulted by a specialist in maxillofacial surgery. After the operation, victims are advised to keep ice in the area of the surgical intervention for 12 hours; they should sleep with their head elevated, sneeze only through the mouth; they should refrain from blowing their nose and sudden movements. Such patients should undergo a repeat medical examination 2 weeks and 2 months after the operation. And after a few months, submucous resection can be performed for a deviated nasal septum.

Cerebrospinal fluid rhinorrhea. Bone fractures in the roof of the ethmoid labyrinth may lead to a leak of cerebrospinal fluid. The fluid that comes out of the nose contains glucose (in such cases, the "Clinistixw test is confirmed by a laboratory test for sugar). Such a CSF leak usually stops on its own, but if it does not, neurosurgical closure of the hole in the dura mater can be performed. To prevent meningitis in such cases, nasal cultures should be taken with a swab and treatment with flucloxacillin and ampicillin should be started - both at 250 mg every 6 hours orally, without waiting for the patient to "become intoxicated."

Hematoma in the nasal septum area. It may occur after trauma and cause nasal obstruction; rhinoscopy shows severe swelling on both sides of the septum. Blood clots should be removed immediately under local anesthesia by incisions, and antibiotics should be given orally to prevent infection (e.g. amoxicillin 250 mg every 8 hours). If a hematoma of the nasal septum is left untreated, there is a risk of necrosis of the cartilage of the nasal septum or "collapse" of the nose.

Foreign bodies in the nose. Most often, they are introduced into the nose by children intentionally. If it is organic material, then purulent discharge from the nose soon appears, inorganic substances can remain inert in the nose for a long time, i.e. without causing any response from the surrounding tissues. If it is possible to establish contact with the child and he becomes sociable, then sometimes it is possible to grasp the foreign body with tweezers and pull it out. You can also use 2.5% cocaine aerosol, after which the swelling of the nasal mucosa decreases, which allows you to suck out the foreign body from the nose with a suction device. If general anesthesia is required, then airway protection is necessary.

Causes of nasal septum perforation. They are varied: postoperative (submucous resection), trauma, forced nose picking, inhalation of chromium salts, sniffing cocaine, the presence of an erosive ulcer (a type of basalioma of the nose), malignant granuloma, tuberculosis, syphilis. The area of the nasal septum perforation constantly bothers the patient, dry crusts form in this area, the ulcer often bleeds. Treatment is symptomatic. Surgical closure of the perforation is difficult to perform.

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