nasal bone fracture

1.nasal bone fracture is one of the common trauma cases in ENT. Nasal bone can be fractured due to motor vehicle accident, trauma secondary to being assaulted or punched on the nose.
2.Usually clinical presentation of nasal bone fracture is straight forward. Patient will complaint of being hit over the nose then followed by nose bleeding. Patient will also have nasal blockage, pain and swelling nasal bridge.
3.The treatment of nasal bone fracture depends on severity of fracture and cosmetically accepted by patient. There few types of fracture of nasal bone,it can be deppressed fracture or deviated fracture to either right or left side.
4.Acute management of nasal bone fracture is to stop bleeding if persistent and to relieve pain. reduction of nasal bone is not mandatory in acute phasa because it may complicate to other related structure on the face.
5.Patient will be given analgesic and decongestant nasal spray if patient having nasal blockage within time of injury until 7 to 10 days. Then within day 7 to day 10 of injury, reduction of nasal bone can be done under local naesthesia or general anaesthesia.
6.Xray of nasal bone is not indicated before the procedure but it can help surgeon the facilitate how much reduction have to be done. The usual practise to look for how much reduction doen is by inspecting nasal bridge from up view of forehead of the patient after procedure.
7.The procedure of nasal bone reduction is a minor procedure.It can be done at treatment room only. Patient will put on cocaine nasal packing 5 to 10 minutes before procedure as for internal nasal cavity analgesic. Then after that, surgeon will infiltrate lignocaine/marcaine at superior nasal bridge each side to block intratrochlear nerve. Once cocaine packing removed, another local infiltration given at each side of inferior turbinate to block sphenopalatine nerve.
8.By using warsham forceps, contralateral side of nasal bone outfractured by rotating laterally, then ipsilateral side of deviation of nasal bone fracture infractured using thumb until it centered.
9.thermoplastic splint put over nasal bridge until up to 1 week to avoid fractured nasal bone deviated back.
10.Patient will given decongestant nasal spray as well as oral decongestant and analgesic afterwards. Thermoplastic splint opened up after 1 week. Then it is up to patient whether he is quite satisfacted cosmetically of his nose after procedure or not. If he is still not satisfy the other option is plastic surgery which is costly and risky. The main purpose of procedure to relieve nasal blockage to have optimal function of nose and the other hand is for cosmetic..