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Nose injuries

Damage to the external nose and walls of the nasal cavity are more often observed in men and in children. Injuries to the skin of the nose are found in the form of a bruise, bruising, abrasion, and injury. During the examination, it must be borne in mind that damage often only appears to be superficial in appearance, but actually penetrates more deeply; in such a wound there may be a hardly detectable foreign body; these injuries are often accompanied by concussion. If such suspicions arise during the examination, it is necessary to take an x-ray of the nasal bones, computed tomography (CT) scan and conduct a neurological examination. Bruises and bruises of the external nose, except for a cold lotion immediately after an injury, do not need treatment; abrasions are treated with 5% tincture of iodine.

Nose wounds come in the form of various forms of skin wounds that penetrate and do not penetrate the nasal cavity; a wound may be accompanied by a defect in a part of the external nose, most often the tip or wing. Penetrating wounds of the nose are accompanied by damage to the bone-cartilaginous skeleton, which is determined by the palpation of the wound by the probe.

The internal tissues of the nose are often damaged to a limited extent in the form of scratches and abrasions of the mucous membrane of the usually anterior nasal septum. If infection gets into such wounds, an abscess and perichondritis of the nasal septum can occur.

Injuries to the nose often lead to damage to various parts of the nasal bridge - dislocations, fissures, fractures without displacement and with displacement of the bones and cartilage of its skeleton.

In most cases, fractures damage the nasal swelling and nasal septum (Fig. 6.6). With severe injuries, a fracture of the frontal processes of the upper jaws and paranasal sinuses occurs. Damage due to minor injuries is usually limited to the integumentary tissues of the nose; with more significant injuries, as a rule, soft tissues, bones and cartilages of the nose are affected simultaneously; sometimes with severe and even extensive injuries, the skin of the nose remains intact. Gunshot wounds are often accompanied by a partial or complete detachment of the nose, fragmentation of its skeleton and surrounding parts of the face. A bullet or splinter can penetrate through the nose into the region of the paranasal sinuses, into the cranial cavity, neck, etc.

D and a gnostics is based on data from an external examination, palpation, probing, endoscopy, and radiographic examination. Based on the clinical picture, an optometrist, a neurologist are examined, laboratory and other studies are performed. At the time of injury, shock, nausea, vomiting, loss of consciousness are possible. Each of these symptoms indicates a concussion and, possibly, a fracture of the base of the skull, which requires immobilization of the patient’s head, neurological examination and treatment. Bleeding can be external and from the nasal cavity. Usually it stops on its own shortly after an injury, however, if the ethmoidal arteries are damaged, nasal hemorrhage is abundant and stops only after nasal tamponade. Conjunctival and subcutaneous bruising should be distinguished from hemorrhages in the periorbital tissue of both orbits (symptom of glasses), which is recorded in case of fractures of the base of the skull and damage to the cavernous sinus of the skull.

Fig. 6.6. Model of a fracture of the nasal bones (in the basal plane).

a -

normal nose structure

: 1 - septum of the nose; 2 - nasal bones; 3 - frontal processes; b -

fracture in the form of a flattening of the nasal vault due to separation of sutures between the nasal bones, frontal processes and nasal bones

; in -

a fracture of the nasal bones with separation of the frontal process and nasal bone on the side of the impact and a fracture of the frontal process on the opposite side;

g -

fracture with lateral displacement of the nasal bridge and retraction of fragments of the nasal slope inward

.

On examination and palpation, a painful edematous swelling of the tissues in the area of ​​injury is determined, which remains for several days. External deformation of the nasal bridge with a shift to the side or back definitely indicates a fracture of the nasal bones. When feeling in such cases, bone protrusions on the back and slopes of the nose are revealed. Significant traumatic force can cause fragmentation of the nasal bones - in this case, pathological mobility of the nasal dorsum and, possibly, crepitation of bone fragments will be determined by palpation. A displacement of the nose at the base indicates a fracture of the processes of the upper jaw and nasal bones.

The presence of subcutaneous air crepitus indicates a fracture of the ethmoid bone with a rupture of the mucous membrane. Air blowing through the nose blows through the injured tissue under the skin of the face. Fracture of the sieve plate confirms liquorrhea from the nose. With rhinoscopy, certain violations of the configuration of the walls of the nose can be recorded. Often the cartilaginous part of the nasal septum, due to its elasticity, remains intact, while the bone part is damaged.

An X-ray examination usually provides valuable information about the nature and prevalence of a fracture of the bones of the nose and face, especially in conditions of significant swelling and infiltrative swelling of the soft tissues. However, the absence of radiological changes does not allow to exclude a fracture of the nasal skeleton.
In some cases, there is a need for CT.

Treatment for fractures of the nasal bones is most effective in the first hours and days after the injury. Depending on the extent of local trauma and the severity of general and neurological symptoms, therapeutic measures are taken. Bleeding from injured tissues must be stopped without delay, since its continuation can threaten the patient's life. Since injury to the integumentary tissues during injuries is always associated with a skid of infection, immediate administration of tetanus toxoid serum is indicated according to the appropriate scheme, and with bites of animals (usually dogs), rabies serum. If concussion of the II or III degree is diagnosed according to the anamnesis and objective research, reduction of the nasal bones and extensive surgical interventions should be delayed if possible for a day or more and appropriate neurological treatment should be carried out.

In such cases, only primary surgical treatment of the wound is effective. At the same time, the edges of the wound are not excised, but only non-viable tissues are removed. Due to the abundant blood supply to the face, healing here is going well. The wound is washed with a solution of hydrogen peroxide and dried.

Seams are frequent, preferably horsehair or thin silk; the dressing is usually not applied. The primary suture on the face can be applied within a day after the injury, however, in some cases, a wound closure is also possible later (up to 48 hours).

Fragments of the nasal bones with lateral displacement of the nasal bridge are adjusted with the thumb of the right hand when bent to the left and, accordingly, of the left hand, when bent to the right. Finger pressure can be significant. At the moment the fragments are displaced to the normal position, a characteristic crunch is heard. Anesthesia is sometimes not required, but it is better to introduce a solution of novocaine into the area of ​​injury or to perform an operation under short-term anesthesia, given that the reduction itself takes 2-3 seconds.

Fragments of the nasal bones displaced posteriorly are adjusted by nasal elevators (Fig. 6.7) according to Yu.N. Volkov. After anesthesia of the mucous membrane by lubrication with a 2% solution of dicaine or under short-term anesthesia, the right or left Volkov nasal elevator is introduced into the nasal cavity, respectively, to a predetermined depth and anterior traction

restore the normal anatomical position of the nasal bridge. When the posterior fragments of both nasal bones are displaced, both elevators are introduced into the nose simultaneously. When the displacement is posterior and to the side, the reduction is carried out by traction anteriorly with one elevator and at the same time the lateral displacement is adjusted with the finger of the hand. In the absence of elevators, reduction of the nose bones is carried out with straight tweezers, the ends of which are wrapped with gauze.

In most cases, after reduction, anterior tamponade of one or both halves of the nose is required to fix the fragments. An indication for anterior tamponade after reduction is the mobility of bone fragments, determined by palpation. In case of multiple fractures of the nasal bones, the fixation, which can be provided with turunda tamponade, impregnated with molten paraffin immediately before the nose (melting point 50–54 ° C), is more durable and long. In this case, it is enough to plug only the upper and middle sections of the nose, since paraffin quickly hardens and the tampon is well held. The advantages of such a tamponade: a firm fixation of fragments is provided and breathing through the nose is maintained. A paraffin swab can be in the nose for up to 12 days (according to Yu.N. Volkov), which is important for the proper fusion of bone tissue. An ordinary gauze swab must be removed 3-4 days after the swab.

Most often, after adjustment, no external fixation is required, however, in rare cases, with a multi-split fracture, the nose does not hold on its own, therefore, fixing rollers and plaster casts of various types are applied. Usually, the nasal bones are corrected on the 1st day after the injury, however, with a later treatment of the patient, during the next 3 weeks, although the difficulties of redress increase significantly. In cases where the reduction of bone fragments was insufficient or was not performed at all, a persistent lateral displacement of the nasal bridge is formed. Most effectively, such “chronic” deformities are corrected with the help of a redressor - Bezapapnoy’s rhinoclast, under which foam rubber is placed at the moment of impact to save skin.

Sometimes, with extensive nasal trauma, the crushing of tissues is so great that it is not possible to restore the configuration of the external nose. In such cases, after wound healing using autoplastic surgery, the external nose is reconstructed or made of plastic to match the color of the skin of the face.

Often there are injuries of the nose with a separation of its tip or wing; while patients usually bring a torn piece. In such cases, after the initial treatment of the wound, the wing or tip of the nose is carefully sewn into place.

However, such plastic surgery is possible if no more than 24 hours have passed after the injury. In the absence of a torn part of the nose, it is advisable to perform acute plastic surgery of the defect at the same time using the movement of skin grafts on a wide leg from the side of the cheek for these purposes.
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Nose injuries

  1. Nose injuries
    Clinical picture Damage to the external nose is very common. The degree of damage to soft tissues, bone and cartilage skeleton depends on the nature of the injury, the direction and strength of the impact. The nasal bones and septum are most often damaged, and fractures of the frontal processes of the upper jaw and the walls of the paranasal sinuses are less common. Sometimes there is damage to the nose with a break in its tip or edge. Injuries
  2. Mechanical injuries of the external nose. Emergency treatment
    Damage to the external nose and walls of the nasal cavity is more often observed in men and in children. Injuries to the skin of the nose are found in the form of a bruise, bruising, abrasion, and injury. During the examination, it must be borne in mind that damage often only appears to be superficial in appearance, but actually penetrates more deeply; in such a wound there may be a foreign body; these damages
  3. Injuries to the nose and sinuses
    The nature of the injury depends on the strength and direction of the impact. There are open and closed herbs. Most of them are accompanied by nosebleeds, and with severe trauma, loss of consciousness and shock can occur. Stopping bleeding, if possible - reduction of bone fragments under anesthesia.
  4. Medical sorting of injured ear, nose, throat
    On the battlefield and on the BCH, the victims are divided into two groups: - the first - the wounded with signs of suffocation (frequent hoarse breathing, blueness of the face, motor anxiety) or with bleeding from the nose, ear, mouth, and neck. The wounded of this group are assisted and evacuated to the MPP in the first place; - the second - wounded with damage to the ENT organs without signs of suffocation and bleeding,
  5. Characteristics of medical care for injuries of the ear, throat, nose
    Those injured with mechanical trauma of ENT organs receive help at the stages of pre-medical, first medical and qualified care only for respiratory distress, ongoing bleeding, heavy blood loss and shock. In emergency care due to bleeding from damage to the blood vessels and respiratory tract, approximately 10.5% of the ENT of the wounded are in need (bleeding is observed in 7.5%
  6. Deformations of the nasal septum, synechia and atresia of the nasal cavity
    The etiologic deformation of the nasal septum may be due to physiological, traumatic, and compensatory factors. Physiological curvature occurs when there is a mismatch in the growth of the nasal septum and the bone frame into which it is inserted. The growth of the septum is slightly ahead of the growth of the facial skeleton, so its curvature occurs. In childhood, physiological
  7. LESSON 13 First aid for injuries. Closed soft tissue damage. Traumatic brain injuries. Damage to the chest. Transport immobilization for injuries.
    Purpose: To teach students the differentiological diagnosis of various traumatic conditions, the rules of first aid to the victim. Test questions 1. Injury. Definition Classification of injuries. 2. Closed soft tissue damage. Injury. First aid. 3. Stretching. Complaints First aid. 4. The gap. Complaints First aid. 5. The syndrome of prolonged crushing. Pathogenesis. The clinical picture.
  8. The mechanism of injury. Classification of injury types
    A. External forces Newton’s law of inertia: “A moving body continues to move until an external force acts on it.” 1. The horizontal moment. Force = MA = MDD = V2 - V1 / t = braking V2 = final speed V1 = initial speed 2. Gravity. Force = GmM / R2 = mg g = GM / R2 = acceleration due to gravity = 9.8 m / s2 R = radius of the Earth; G = grav. Constant; M = mass
  9. Anatomy of the nose
    In clinical and anatomical terms, the nose is divided into external and internal departments. The external nose, nasus externus, is an important anatomical component of the face, largely determining its individual characteristics. The external shape of the nose is compared with a trihedral pyramid. In the outer nose, there are: 1) the root located between both eye sockets, 2) the tip (tip) of the nose, 3) the back
  10. Fracture of the bones of the nose and paranasal sinuses
    Case: Face asymmetry is determined in the form of deformation of the external nose, sinus front wall sagging, skin damage, palpation pain (sometimes with a crunch, crepitation of bone fragments and air in the subcutaneous tissues), edema, eyelid hematoma and usually bleeding from the nose. Depending on the depth of damage, fractures can be isolated or combined with a head injury
  11. NOSE CAVITY
    The nasal cavity (cavitas nasi) is the initial section of the respiratory tract and, at the same time, the organ of smell. Passing through the nasal cavity, the air either cools, or warms up, moisturizes and purifies. The nasal cavity is formed by the outer nose and bones of the facial skull, divided by a septum into two symmetrical halves. The nostrils are the front openings in the nasal cavity, and through the choanas are the back openings
  12. Syphilis of the nose
    Syphilitic lesions of the nose are currently extremely rare. Primary syphilis of the nose develops when pale treponema penetrates through microscopic lesions of the skin or mucous membrane of the nose (the so-called extragenital route of infection). This is possible as a result of infection by poorly disinfected instruments used in the examination of patients with syphilis, or
  13. Polyps of the nose
    Polyps of the nose is one of the complications of year-round allergic rhinitis. Usually they are localized on the middle nasal concha, around the openings of the maxillary sinuses and the ethmoid labyrinth. Polyps are observed in both allergic and infectious rhinitis. Polyps that occur with allergic rhinitis look like whitish or gray, shiny, gelatinous formations. Polyps in chronic
  14. Tuberculosis of the nose
    Tuberculosis of the nose, according to the clinical classification of tuberculosis (1973), is included in the group of tuberculosis of the respiratory system and a subgroup of tuberculosis of the upper respiratory tract. It usually develops in the presence of a tuberculous focus (most often in the lungs). Mycobacterium tuberculosis (Koch's bacillus) penetrate the nasal cavity and its external integument endogenously through the blood and lymph vessels.
  15. Anterior Tamponade
    Purpose: stop bleeding from the middle sections of the nose. Equipment: rubber gloves, tray, napkin, turundo, bandage, bottle with 3% hydrogen peroxide solution, a container with 3% chloramine solution, forceps or tweezers. Prerequisite: the procedure is performed if nosebleeds do not stop after applying a piece of ice to the nose and nose and after pressing the wings of the nose to
  16. Tuberculosis of the nose
    Mycobacterium tuberculosis, spreading along the lymphatic and circulatory pathways, enter the nose from the focus, which may be in the lungs, joints or larynx. In rare cases, the infection enters the nasal mucosa by contact. The pathomorphological substrate of the disease is infiltration - an accumulation of specific tubercles in the submucosal layer. Tuberculous tubercle
  17. Nosebleed
    Physical blockage The following definition refers to normal nosebleed that is easy to stop. If you are talking about severe bleeding that is difficult to stop, see the article BLEEDING. Emotional blocking If blood begins to flow from the nose for no apparent reason, this means that the person feels sad or annoyed. Кровотечение из носа начинается тогда, когда
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