The nose has important functional and aesthetic functions. Aesthetically, it has a well-recognized feature on the face. Functionally, it is important for normal breathing, air humidification, speech production and sensations associated with smell.
The main causes of nasal bone fracture are sports activities, physical aggressions, falls and motorcycle and automobile accidents.
Surgical management in cases of nasal fractures will depend on several factors. The time of the fracture, the type of anesthesia, the extent of the fracture and details of the surgical approach should be considered.
It is recommended that nasal fractures be addressed as soon as possible, usually within the first week of the fracture occurring. Sometimes this will not be possible due to the formation of post-traumatic edema. However, it should be borne in mind that procedures postponed for more than 1 week may be more difficult to be treated with closed reduction only . Early treatment facilitates the healing process, limits the patient’s disability and reduces the period during which the patient will be away from their activities.
Some surgeons choose to perform surgical treatment under local anesthesia and sedation. However, this approach may increase the risk of bleeding around the airways. For this reason, depending on the condition of the patient and the surgeon / hospital, general anesthesia should be indicated.
Open Treatment Of Serious Nasal Injuries
Complex nasal fractures that require open reduction are usually associated with fractures in other regions, such as the frontal, ethmoid and orbital bones. In such cases, an existing laceration can be used as an incision on the site, or a bicoronal access can be performed.
Some patients who suffer a nasal fracture may, in a second surgical procedure, benefit from secondary rhinoplasty and / or septoplasty to treat residual deformities after performing closed reduction techniques. In such cases, it is usually expected to take about 6 months or more for healing and remodeling to, after that, proceed to secondary surgeries.
Complications – Septum Hematoma
The septum hematoma is a rare complication of nasal trauma, which can present with nasal obstruction, pain or fever, when infected. It should be treated quickly to avoid necrosis of the septal cartilage. Treatment includes incision, drainage, nasal packing to prevent the formation of a new hematoma and antibiotic therapy . In these cases, the nasal packing should be maintained for 3 days, changing it daily .