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Nasal Bone Fracture: Causes, Symptoms & Treatment

A nasal bone fracture is a break of the nasal bone, most commonly caused by direct impact. It is one of the most frequent facial bone injuries.

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Things worth knowing about "Nasal bone fracture"

A nasal bone fracture is a break of the nasal bone, most commonly caused by direct impact. It is one of the most frequent facial bone injuries.

What is a Nasal Bone Fracture?

A nasal bone fracture refers to a break of the bony part of the nose, known as the nasal bone (Os nasale). It is one of the most common fractures of the facial skeleton and occurs frequently in sports injuries, road traffic accidents, and physical altercations. The injury can range from a minor crack to a severe displacement of the nasal bone.

Causes

The most common causes of a nasal bone fracture include:

Sports injuries: for example in football, handball, martial arts, or cycling
Falls: particularly common in children and elderly individuals
Road traffic accidents: impact against the steering wheel or airbag
Assaults: direct blows to the face
Workplace accidents: from flying objects or equipment

Symptoms

Typical signs of a nasal bone fracture include:

Pain in the nasal area, especially when touched
Swelling and bruising (haematoma) around the nose and under the eyes
Nosebleed (epistaxis)
Visible deformity or deviation of the nose
Difficulty breathing through the nose due to swelling or displaced bone
A crunching sensation (crepitation) when the nose is touched

In more severe cases, a septal haematoma may develop -- a collection of blood within the nasal septum that requires prompt treatment to prevent cartilage damage and possible septal perforation.

Diagnosis

Diagnosis is typically established through a clinical examination by a physician, including palpation of the nose and visual inspection for any deformity. Additional diagnostic measures may include:

X-ray: to visualise the bony structure, though limited in sensitivity
Computed tomography (CT scan): recommended for complex injuries or suspected additional facial fractures
Nasal endoscopy: to assess the nasal septum and interior of the nose

Treatment

Conservative Treatment

For minor, non-displaced fractures without significant deformity, surgery is often not required. Conservative management includes:

Ice application to the injured area during the first 48 hours to reduce swelling
Pain relief with over-the-counter medications such as paracetamol or ibuprofen
Elevating the head to help reduce swelling
Avoiding physical exertion and contact sports for several weeks

Surgical Treatment

Displaced or significantly deformed fractures require surgical intervention. Ideally, this should take place within the first 5 to 10 days after the injury, while the bone is still repositionable. Possible procedures include:

Closed reduction: manual realignment of the nasal bone under local or general anaesthesia
Open reduction: surgical approach for complex fractures or when simultaneous correction of the nasal septum is required (septoplasty)

Follow-Up Care

Regular medical follow-up is recommended after treatment. Physical activities, especially contact sports, should be avoided for at least 4 to 6 weeks. A protective splint or nasal cast may support the healing process.

References

Murray JAM: Nasal fractures. In: Gleeson M (ed.) Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. 7th edition. Hodder Arnold, London 2008.
Ondik MP, Lipkowitz G, Dutton J, Berkowitz R: The treatment of nasal fractures in the 21st century. Archives of Facial Plastic Surgery, 2009; 11(6): 391-397.
World Health Organization (WHO): Injury and Violence Prevention. www.who.int/violence_injury_prevention

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