Injuries to the nose rank first among the injuries of the upper respiratory tract. This is due to the location of this organ (nose) and its frequent injuries. By the nature of the damage, nose bruises, fractures, wounds are distinguished. Isolated trauma to the external nose is most common. By the nature of Nasal trauma, largely depends on the strength, direction of the blow, and the traumatic factor (blunt, sharp object). In the event of an injury to the nasal skeleton, cracks, fractures, dislocations of the bones and cartilage of the nose may occur. Fractures of the nose are most often exposed to the nasal bones and the nasal septum, sometimes to the frontal processes of the upper jaw.
When exposed (hit) on the nose from the side, the edge of the nasal bone is injured, the nasolabial articulation is disrupted and the nose shifts to the side. Sometimes, upon impact, the nasal bones sink and the nasal dorsum becomes flattened. If the nasal bones are pressed in and the nasal vault is reduced, the bony part of the nasal septum is usually deformed. In this case, a concavity is formed on one side of it, and convexity on the other. With the growth of the child, there is an increase in the deformation of the bones and cartilage of the nose. Sometimes there is a dislocation of the quadrangular cartilage from the notch in the vomer. Subluxation of the cartilage of the nose is very demonstrative.
When struck from the front on the lower part of the nose, the cartilage of the nasal septum is often damaged, while the cartilaginous part of the external nose may not be deformed, since it is highly elastic. Sometimes there is a drooping of the tip of the nose due to post-traumatic perichondritis.
A feature of nasal injuries in preschool children, in whom the bone sutures are less resistant than the bones themselves, is the separation of the sutures. For example, when the nose is bruised, directed from the front, the bones are introduced, the nasal vault is flattened when the sutures between both nasal bones are separated. In case of injury to the nose, paranasal sinuses, and other bone formations of the skull, injury to the olfactory analyzer in its various parts is possible at the same time due to squeezing of the olfactory filaments by displaced bone fragments. The impairment of smell can be the result of hemorrhages in the olfactory region of the nose, followed by the formation of scars that compress the olfactory filaments.
Symptoms of nasal trauma
With a nose injury, headache, fever, nosebleeds, hemorrhage in the skin of the nose and eyelids, and swelling of soft tissues are noted. Due to the development of edema of the soft tissues of the face (on the 2-3rd day), crepitus with a nose injury may not be detected. A fracture of the nasal bones with rupture of the mucous membrane may result in subcutaneous emphysema of the eyelids. Violations of nasal breathing, smell, and other physiological functions of the nose with its injury are caused by deformation of the nasal cavity.
Violation of smell with a nasal injury is more pronounced in cases where nasal breathing is significantly difficult or the olfactory gap closes. A decrease or complete absence of smell in case of a nose injury is more often observed on the side of its injury. If this is caused by a reaction of the mucous membrane of the nasal cavity to injury or hemorrhage, then subsequently the sense of smell may improve on its own or completely recover. However, with injury to the bones of the nose and compression (especially when they break the olfactory filaments), the violation of the sense of smell, as a rule, is persistent and its improvement occurs relatively rarely.
The diagnosis of open injuries of the nose is not difficult. With an isolated injury of only the skin of the nose in the form of bruises, abrasions, bruises, often no additional examination is required. If Nasal trauma is closed, diagnosis can be difficult due to tissue edema. In case of a fracture of the bones of the nose, including its septum, X-rays are taken in the profile and nasal-chin position, computed tomography of the bones, and paranasal sinuses (CT).
Treatment of nasal trauma
In the presence of crushing and contamination of the wound with a nasal injury, 0.5 ml of purified adsorbed tetanus toxoid is injected subcutaneously (sample). In the absence of a reaction, purified tetanus toxoid in a dose of 3000 IU is injected into another part of the body with another syringe. Before the reduction of bone fragments in case of a nose injury, local (1% lidocaine solution) or general anesthesia is performed. External reduction of the fragments of the nasal bones is more often performed by pressing fingers on the displaced parts of the nasal skeleton. Reduction of the bones from the side of the nasal cavity is usually carried out using a blunt narrow elevator, on which a sterile rubber tube is preliminarily put on, providing atraumaticity of the mucous surface of the nasal cavity.
External fixation of the nose is performed using tight gauze rollers applied along the lateral slopes of the nose and held with adhesive plaster, or using fixators modeled for children. Internal fixation of the nasal bones is performed with tampons, which, if necessary, can simultaneously serve to stop nosebleeds. Tampons for nasal trauma are pre-soaked with synthomycin or streptocidal emulsion (5-10% solution).
Children with facial emphysema with a nose injury usually do not carry out any special measures, since the air trapped in the tissues dissolves rather quickly and without a trace. For edema, use a cold (ice pack). If breathing through the nose is absent or difficult, nasal drops of 0.5% naphthyzine solution are prescribed.
In case of violation of the integrity of the skin of the nose and fragmentation of bone or cartilage, the primary surgical treatment of the wound is performed according to generally accepted rules. In this case, it is important to preserve viable tissues as much as possible, remove necrotic areas, and superficially located foreign bodies, if any. Foreign bodies after a nasal injury that lie deep in the tissues must be removed with great care in the operating room, where everything is ready in case of bleeding.
Children with a nasal injury in a state of shock are provided with maximum rest, they are warmed up, pain relievers, antihistamines (pipolfen, suprastin) are prescribed, and heart drugs, if necessary.
If the damage to the nose is combined with a concussion of the brain, the patient is given complete rest with strict bed rest for at least 2-3 weeks, an ice pack is placed on his head, dehydration therapy is used (20% glucose solution, 25% magnesium sulfate solution), symptomatic treatment and, if necessary, antibiotics, sulfonamides in age-related doses.
In most children, with a nasal injury, it is also necessary to restore the physiological functions of the nose. The reposition of the nasal bones should not only improve nasal breathing but also lead to the restoration of the usual level of airflow in the nose during inhalation and exhalation, which ensures normal fluctuations in air pressure in the nose and paranasal sinuses, as well as in other parts of the respiratory tract. Therefore, the main attention during the reposition of the nasal bones is paid to the restoration of the usual configuration of its cavity, modeling both its lower and upper parts. In this case, the airstream at the moment of breathing rises and goes along the usual arcuate route, getting into the olfactory slit during forced inhalation, which ensures the restoration of the olfactory function.
Damage in the nasal cavity after trauma sometimes leads to scar fusion between its parts or to the replacement of tissues (mucous membrane, septum, and concha) with massive, thick scars that disrupt the respiratory and olfactory functions of the nose. To prevent cicatricial adhesions in case of nasal injury, plates and tubes made of various materials (X-ray film, rubber, Teflon) are used, which are inserted into the nose after reduction. As a result of necrosis of the cartilage of the septum of the nose due to trauma, a saddle nose can form.
Paranasal sinuses trauma
Injuries to the paranasal sinuses (paranasal sinuses) are often associated with injuries to the nose. Usually, they are caused by transport accidents, pranks, various emergencies. More often, with injuries of the paranasal sinuses (paranasal sinuses), the frontal and ethmoid sinuses are affected, usually with damage to the surrounding organs and tissues (eyes, lacrimal sac, nasolacrimal canal, cranial cavity contents). In case of injury to the maxillary sinus, the tissues of the cheeks, the oral cavity, and the dentition are also damaged.
Symptoms of paranasal sinuses trauma
The symptoms of an injury to the paranasal sinuses (paranasal sinuses) depend on the combined damage to neighboring organs. Prolonged unconsciousness often indicates a concussion or contusion of the brain with hemorrhage into the cranial cavity. An almost constant symptom of a sinus injury (sinuses) is a headache. With injuries to the bones of the skull and brain, vomiting, dizziness, congestion in the fundus, pulse changes, fever, and sometimes memory and psyche disorders occur. Almost always, injuries to the paranasal sinuses (paranasal sinuses) accompany bleeding from the wound and nose.
With a closed injury to the paranasal sinuses (paranasal sinuses), subcutaneous emphysema sometimes occurs, determined by a crunching sensation during palpation of the skin in the area of its swelling. In case of damage to the cerebral walls of the sinuses, and intracranial air tumor (pneumocephalus or pneumatocele) can be observed. Air penetration into the cranial cavity after an injury to the paranasal sinuses (paranasal sinuses) occurs due to the difference between intracranial and atmospheric pressure. An important symptom of a violation of the integrity of the bones of the skull is liquorrhea, often originating from the area of the sieve plate or frontal sinus.
Symptoms, when the sphenoid sinus is injured with a skull injury, is also determined by the state of neighboring organs. Bleeding from the nose is possible with damage to the cavernous sinus. With trauma to the paranasal sinuses (paranasal sinuses), blindness and paralysis of the oculomotor nerves may occur. In the case of rupture of the internal carotid artery with hemorrhage into the cavernous sinus, pulsating exophthalmos is sometimes observed, i.e. bulging of the eyeball synchronous with the pulse.
With some injuries of the paranasal sinuses (paranasal sinuses) - falling from a height onto a sharp object, etc. - the presence of foreign bodies in the sinuses for a long time may remain unrecognized. Damage to the paranasal sinuses (paranasal sinuses) is fraught with the risk of orbital complications. Injury to the paranasal sinuses (paranasal sinuses) can result in lacrimation (in the event of damage to the nasolacrimal canal, as well as an impaired sense of smell (respiratory hyposmia or anosmia).
Diagnosis of paranasal sinuses trauma
It is important to find out the mechanism of injury to the paranasal sinuses (paranasal sinuses), which allows you to more accurately classify it and identify the features of the clinic. Deformation of the bones of the facial skull, bleeding from the nose, pain, difficulty in nasal breathing (less often anosmia), sometimes loss of consciousness, subcutaneous emphysema (with rupture of the nasal mucosa), crepitus of bones make it possible to recognize a combined fracture of the bones of the nose and paranasal sinuses.
Anamnesis, otorhinolaryngological and X-ray examinations, computed tomography of bones and paranasal sinuses (CT), micro-rhinoscopy are important in making a diagnosis of trauma to the paranasal sinuses (paranasal sinuses).
Complications of paranasal sinuses trauma
Rapid healing of fractures of the bones of the paranasal sinuses (paranasal sinuses) leads to insufficient connection and fusion of tissues, and therefore to deformation of the face, which can be avoided by early recovery and fixation of fragments. Late complications of fractures of the paranasal sinuses (paranasal sinuses) can be plate-shaped deformity of the face, an abnormal fusion of fragments, delayed eruption of teeth, or their incorrect formation.
Deformation of the face is possible due to insufficient connection, which interferes with the growth and development of facial bones in children. Among the complications of trauma to the paranasal sinuses (paranasal sinuses), diplopia (double vision), saddle nose, traumatic hypertelorism are distinguished. Nasal liquorrhea (the outflow of cerebrospinal fluid from the cranial cavity, a bone defect of the skull bones at the site of rupture of the dura mater) may result in acute meningitis. Premature loss of teeth due to trauma to the paranasal sinuses (paranasal sinuses) leads to abnormal development of the facial bone skeleton in children, which requires joint action with the dentist.
Timely effective assistance for trauma to the paranasal sinuses (paranasal sinuses) reduces the number of complications associated with fractures of the skull bones. With severe trauma to the paranasal sinuses (paranasal sinuses), post-traumatic headache, epilepsy, loss of smell (with injury to the sieve plate), etc.