How to identify a nasal fracture in a child: photos, symptoms, signs and treatment

General concept

Nasal fracture in a child - photo:

A fracture is a violation of the integrity of the bone with the subsequent separation of its component parts. A fracture can occur as a result of physical force, a blow, or an inflammatory process, although the latter option is quite rare.

When a fracture occurs, pathological mobility of the bone and its parts occurs, a characteristic crunch is heard, nearby tissues swell, and sharp pain occurs.

Depending on the degree of the fracture and its type, some characteristic symptoms of the pathology may be absent , while others, on the contrary, will be more intense.

Features of the structure of the organ

The nose is a complex organ that performs a number of important functions. There are 2 parts of the organ: external and internal (nasal cavity).

The outer part is visible to the naked eye on the face of each person, and it has purely individual structural features, as a result of which the shape of the nose is different for each person.

The organ consists of 2 paired bones that are attached to the frontal part of the skull. The wings of the nose and its tip consist of cartilaginous tissue .

The inside of the nose is a cavity bounded by the nasal bones and the hard and soft palate. The nasal cavity is divided into 2 parts by an internal septum, which consists of cartilage tissue.

A known feature is that this partition in each person is slightly shifted to the side, so each of these two parts differs in size.

The anatomical features of the structure of the nose, the presence of a large number of constituent bone parts and cartilaginous tissue, make this organ very vulnerable, therefore, it can easily be broken, even with minor mechanical impact.

There are several main types of nasal bone fractures:

Frontal depression . It is considered the most common type of nasal fracture in children. In a child, both nasal bones and the septum are simultaneously broken, resulting in a violation of the integrity of his pyramid. In especially severe cases, the bones of the upper jaw are affected. This type of fracture leads to a significant change in the shape of the nose, when it becomes very wide and takes on a saddle shape.
Nose displacement. As a result of the traumatic impact, one of the paired bones breaks and the integrity of the nasal septum is damaged. As a result, a cosmetic defect occurs - a crooked nose.
Irregular comminuted fracture . A complicated form of injury that occurs when there is multiple damage to the middle part of the face.
Lateral indentation . Occurs during a side impact.

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Nasal injuries in children

During treatment, the physiological functions of the nose are restored on the 7-10th day after injury. Ambulance and emergency care depends on the patient’s condition, the nature and degree of traumatic damage to the external nose and paranasal area, and associated complications. First of all, stop bleeding using local and general means. In case of open trauma to the nose, with cut and bruised wounds, the most gentle primary surgical treatment is performed, free bone fragments, necrotic tissue, superficial foreign bodies are removed, and anti-tetanus serum or toxoid is administered. In case of hematoma or abscess of the septum or other parts of the nose, they are opened, washed with an aseptic solution, the abscess cavity is drained, and granulations are removed. To restore the shape of the nose and prevent cosmetic and functional defects, the nasal bones are repositioned. Indications for surgery: deformation of the external nose and nasal septum, fracture and displacement of bone fragments (on x-ray), disruption of the respiratory and olfactory functions of the nose. Reposition is performed endonasally with the help of an elevator or raspator, which is fitted with a rubber tube to reduce trauma to the nasal mucosa. There are special sets of paired nasal elevators by M. F. Mannakova, Yu. N. Volkova for repositioning the nasal bones in children of different ages. Endonasal manipulations are combined with external reposition of the nasal dorsum. Once the bone fragments are in the correct position, they are fixed using anterior tamponade with an emulsion of synthomycin or iodoform. Tampons made of absorbable material (oxidized regenerating cellulose and gelatin sponge, which completely dissolve after 3-5 days) are often used. To reduce trauma to the mucous membrane of the nasal cavity during anterior tamponade, rubber balloons are also used, into which gauze swabs and strips of foam rubber are inserted. This greatly facilitates the removal of tampons, making the procedure quick, painless and bloodless. Tampons are removed from the nasal cavity 24-48 hours after surgery. To ensure nasal breathing, before nasal tamponade, polymer drainage tubes are passed through the lower nasal passages into the nasopharynx. For complex traumatic deformities of the external nose after bone reposition, external fixing plaster bandages or bandages with collodion, as well as those made of polymer materials or organic glass, are used. A plaster cast reliably fixes the fragments of the nasal bones in the correct position; in addition, gypsum is a good adsorbent of wound discharge, secretion of the sweat and sebaceous glands. To prevent the child from pulling out the tampons that are interfering with him, apply a sling-shaped bandage. In the postoperative period, all children with nasal injuries are prescribed anti-inflammatory, hemostatic therapy, and vasoconstrictor nasal drops. When there is a lateral displacement of the nasal dorsum without retraction of the bone walls, its digital reposition is performed. In children, all methods of redressing the nasal bones with an external surgical approach that leave scars on the face are excluded. It is advisable to carry out repositioning of the nasal bones as early as possible. The operation can be delayed when children are admitted late after injury, when reactive swelling of the soft tissues is pronounced, making diagnosis difficult, but not later than 7-10 days. Complications. After a nasal injury in childhood, deformation of the external nose, curvature of the nasal septum, and impaired nasal breathing are possible.

Causes

Numerous negative factors lead to disruption of the integrity of the nasal bones in children.

The main reasons to be:

mechanical impact on the nasal area of certain objects during active games and sports (for example, hits with a football or basketball);
falling (for example, while running);
fights;
injuries caused by sudden door opening;
injuries during an accident;
hit by a heavy object (for example, a swing);
playing with objects that are not appropriate for the child’s age.

Causes of injury

In a newborn or children from 1 to 3 years old, even a fall does not always injure the nose, due to the fact that the nasal cartilage is covered with a layer of muscle tissue. He is not yet ossified, but after the age of three the risk of breaking his nose becomes much greater for several reasons:

a child may fall from a height, even a small one, for example from a bed;
fun on the playground, falling from a slide or swing;
Rough handling of objects during the game
in sports training;
If you fall while running, especially if your child falls face down
In an accident.

Parents should monitor the child, remove heavy blunt objects, sticks, and anything that the child could accidentally hit in the face. Doors should close tightly and cabinet handles should be tied to prevent a child from getting hurt if they don't open them.

Symptoms and signs

How to identify a broken nose in a child? A broken nose is a reason to see a doctor as soon as possible. However, how can one recognize this problem and understand that a child has a broken nose?

To do this, it is necessary to evaluate the totality of clinical manifestations that may indicate the presence of a fracture. Such manifestations include:

Bleeding from the nose (internal or external), which occurs immediately after injury.
Painful sensations in the damaged part of the face. Pain can be felt not only when impacting the nose, but also at rest. Although, even with a slight touch, the pain intensifies many times and becomes unbearable. If a child, due to his age, cannot tell his parents about his feelings, he begins to scream and cry loudly.
Swelling and inflammation of the mucous membranes of the nose.
Hematomas or bruises in the eye area on both sides.
Deformation (curvature) of the nose.
Difficulty breathing (if the integrity of the nasal septum is violated, when it blocks the nasal passages). At first after injury, the child breathes only through his mouth, since nasal breathing is impossible.

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Signs of a nasal fracture depending on the type of injury

In medicine, there are several types of damage in question:

Closed fracture of the nose without displacement. The only visible signs are extensive bruising and swelling of the upper part of the face. There is no change in the shape or location of the nose. Visually, there may be a depression of the nose, but the exact location of the fracture can only be determined by palpation. An x-ray is required to confirm the diagnosis. If the injury is severe, then damage to the mucous membrane of the nasal passages is possible and, as a result, bleeding.
Open fracture without displacement. The signs are the same as in the previous case, but the point of injury is determined visually - the skin is damaged, protruding bone fragments are clearly visible.
Displaced nasal fracture. A complex injury that can lead to respiratory failure, purulent tissue damage, problems with water and electrolyte balance, and trigeminal neuritis. You will definitely need to use the work of a plastic surgeon to perform rhinoplasty and restore your appearance.

Common signs of a nasal fracture:

hematomas around the eyes, on the bridge of the nose, can spread to the forehead;
swelling of the upper and central part of the face;
acute pain at the site of injury, aggravated by palpation;
difficult to stop bleeding from the nasal passages;
problems with nasal breathing.

If a comminuted fracture occurs, crepitus may be present - a crunch when touched, pathological mobility (the nose can literally be placed on its side).

The severity of a nasal fracture is determined only after the patient is examined by a doctor. For example, with the slow spread of hematomas and a gradual increase in edema, which are accompanied by increasing headaches, there is a risk of not only the injury in question, but also a fracture of the bones of the base of the skull. And in this case, immediate hospitalization and an extensive examination of the patient, including computed tomography, are required.

How to distinguish from a bruise?

Mechanical trauma to the nose may result in a fracture or bruise. These 2 concepts must be distinguished , since each of these options requires different treatment. How to distinguish a bruised nose from a broken bone?

When a child is bruised, pain occurs, however, if there is a fracture, the pain is much more pronounced.

With a bruise, the pain goes away after a while; with a fracture, the pain persists for a longer period of time.

With a bruise, there is difficulty breathing, however, the child can still breathe through his nose, albeit with difficulty. With a fracture, nasal breathing is impossible.

First aid for a child

Once the parent has realized from the symptoms that the child has broken his nose, he needs to be given first aid before visiting a doctor. Since this type of injury is accompanied by severe pain, first of all the child needs to be helped to calm down.

If an injury with obvious signs of a fracture occurs, parents are strongly advised not to straighten the nose themselves. To help the child reduce pain and relieve swelling a little, you should apply something cold to the injury, this can be ice folded in some kind of bag or bag, or just a towel dipped in ice water. In addition to relieving pain and swelling, applying cold water will help stop bleeding. Bleeding can also be stopped using a cotton swab soaked in a saline solution, which will help the blood vessels shrink. You should never throw your head back, as with normal light bleeding from the nose due to pressure and other reasons, since there is much more blood during a fracture and the child can easily choke on it.

If possible, it is advisable to apply a cream or spray with an anesthetic effect to the injury. After the above procedures have been completed, the child must be taken to the trauma department as soon as possible in order to correctly make a diagnosis. It is best to call an ambulance when you discover an injury, who will definitely provide the correct first aid and take the child to a good specialist. Delaying treatment even for two or three days can lead to improper fusion of bones and doctors will have to manually correct the situation through surgery.

What to do if the temperature rises?

If a fracture of the nasal bones is accompanied by hyperthermia, especially if the child’s body temperature reaches dangerous levels, it is necessary to urgently call an ambulance .

a cool bandage applied to his forehead .

If necessary, give an antipyretic suitable for pediatric use and in accordance with the recommended dosage.

Rehabilitation after repositioning of the nasal bones

To prevent the development of complications (nosebleeds), we leave the child in the hospital for a period of 12 hours to a day - all this time parents or close relatives can be with him.
Upon discharge, the otolaryngologist will set a date for the next visit - to remove tampons, plaster or a follow-up examination. For 2–3 days, the young patient may experience pain in the nasal area. To relieve symptoms, our doctor will recommend age-appropriate pain medications. For 2 weeks, you should limit physical activity and any impact on the nose: you should not wear glasses, touch it, sleep with your nose in a pillow, etc. You should not overuse thermal procedures (take a bath, go to a bathhouse or sauna), as they can cause nosebleeds. If you follow these simple recommendations, your child will quickly recover without any health consequences and will forget about unpleasant sensations.

Diagnostics

In order to make an accurate diagnosis , the doctor must:

examine the patient to assess the clinical picture;
interview the child to establish the nature of the complaints and the situation in which the injury occurred;
do an x-ray and ultrasound of the organ;
You may need to consult other specialists, such as an ENT specialist, a surgeon, an ophthalmologist.

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Treatment for a broken nose in a child

tampons are inserted into the nasal cavity, this is necessary to stop bleeding and maintain the normal position of the bones and cartilage of the nose;

If the child's parents stopped the nosebleed, but the broken nasal bones were not noticed, the doctor will have to break them again, and then restore the bones in place, using local anesthesia;
during treatment, the child is prescribed vasoconstrictor drops and painkillers; usually pain and swelling disappear within five days;
Severe fractures are treated surgically to fix the nasal septum in the correct position, which may require the installation of metal plates;
dressings are performed daily, and the course of treatment is usually 1-2 weeks.
Treatment of a nasal bone fracture

If the nasal cartilage and bones are not repaired in time, complications such as irreversible nasal congestion, problems with the sense of smell, and nasal asymmetry may occur. Several years after the injury, only surgical treatment is required.

In children, bones and cartilage heal much faster than in adults. With timely treatment, the nasal bones can heal within a month. All this time, the child should be monitored by a pediatrician; this is necessary to monitor the recovery of the body. After treatment, your doctor will perform an examination to make sure that your bones and cartilage have healed properly and that your baby is doing well.

Treatment regimen

Treatment of a fractured nasal bone includes several mandatory steps:

Pain relief . To eliminate bleeding, swelling and pain, apply a cooling bandage to the damaged area.
For the same purpose, the child is prescribed painkillers.
To restore nasal breathing, it is necessary to use nasal drops
To prevent infection of damaged tissues, antibacterial therapy .
If necessary, when there is a severe fracture, a procedure is prescribed nose repositioning.
This operation is considered very painful, so it should only be performed by an experienced specialist.
The child must be calmed down and seated in a chair so that he is comfortable. After this, anesthesia is administered (in most cases general). At the same time, ice is placed on the nose. After a few minutes, the doctor presses on the side walls and root of the nose, returning it to its normal physiological position.

First aid for a nose blow

In cases where the injury is not serious, you can do without consulting a doctor. Although experts still recommend bringing your child to an appointment to eliminate possible consequences.

First of all, make sure that the child can calm down and stop being nervous.
It is important to immobilize the baby and explain to him that he cannot speak, make sudden movements, or blow his nose - all this can lead to increased bleeding.
If the baby’s bleeding has not yet stopped, it is necessary to slightly tilt the child’s head forward - this will prevent blood from entering the nasopharynx, which will facilitate the rapid clotting of blood in the sinuses.
It is necessary to place a cold object on the impact zone, ideally an ice pack. If you take a cold item from the freezer, that is, it is quite icy, then you need to wrap it in cloth to create a layer between the ice and the child’s skin. You can also use a cloth soaked in cold water or some cold metal objects if you cannot use ice.
If you are one hundred percent sure that there is no fracture of the nasal bone, then you can do a tamponade. To do this, insert cotton swabs soaked in peroxide into each nostril. If you don’t have peroxide on hand, you can insert dry swabs, but it is advisable to use sterile ones. Keep it in the nasal passages not only until the bleeding stops, but for another 35 minutes after that, then carefully remove it.
You can also use another option to stop nosebleeds. But you need to be absolutely sure that there is no fracture. You will need to simultaneously press the outer sides of the nose on both sides to the septum, hold it for up to 10 minutes.

Care and recovery

A child after a fracture of the nasal bones needs a recovery period and special care .

The duration of the recovery period may vary, it depends on the severity of the fracture, the presence of other injuries that the child may have received during the injury, the general condition of his body and well-being.

Throughout the entire recovery period, the child must be provided with peace, sports, physical activity, the use of glasses, and visits to the steam room are strictly prohibited .