The nose is the most common facial bone to sustain a fracture. Such injuries may result in deformities affecting the outside and inside structures of the nose, which can cause problems breathing, sinus infections, nose bleeds, snoring, nasal obstruction and distorted facial features. The facial surgeon is concerned with septal hematomas (a blood clot in the septum); deviated, impacted septums; crooked nasal bones; cheek, orbit and jaw fractures; and soft tissue lacerations. Findings of trauma-induced nasal fractures and associated injuries are often subtle. Actual deformity is better ascertained through a full clinical assessment several days after injury, once swelling is decreased, and involves a history, physical examination as well as consideration of nasal features prior to injury and force of injury. The type and severity of fracture are assessed by looking at the mechanism of injury. Mild forces may only cause unilateral nasal bone depression; severe blows result in bilateral fractures with septal disruption; and frontal blows cause impaction injuries. Double vision, vision changes, difficulty fully opening the mouth, facial numbness, or severe bruising of the eyes may indicate severe injury requiring further radiologic workup and CT scan. Hematomas, though rare, require emergency drainage. Cartilage is stripped of its nutrient blood supply, resulting in scarring, collapse of the septum and dorsum and, ultimately, obstruction and collapse of the nose.
Orbital injuries require an ophthalmologist to assess for a globe injury. CT scans aid in diagnosing orbital, malar and midface fractures. Displacement, difficulty opening the mouth and double vision are associated with some fractures and require treatment. Most displaced nasal fractures require simple closed nasal reduction or a more involved septorhinoplasty to restore shape and function of the nose. Such procedures allow the best hope at obtaining an excellent aesthetic and functional result. Because children’s noses contain more cartilage, fractures are less frequent. Treatments are conservative to prevent damage to growth plates of the cartilage and bone. Severe deformities are conservatively reduced nonetheless to encourage straight growth of the septum and nose during growth spurts. The Otolaryngologist (ENT) has 5 to 7 years of specialty training in surgical and medical problems of the head and neck. This surgeon can determine whether a patient requires immediate treatment and is adept at state-of-the-art techniques minimizing the need for packing, reducing bruising and discomfort during recovery. In most cases, through closed reduction of fractures, the surgeon achieves excellent aesthetic results and restoration for the nasal airway. Treatments are performed under quick IV sedation or general anesthesia on an outpatient basis.