Nasal trauma refers to an injury to your nose or the immediate area around your nose. These can include internal and/or external injuries. The bones, tissue and cartilage of your nose are in a vulnerable place within the skull, which is why nasal injuries and nasal trauma are common.
Types of nasal trauma
There are various types of nasal trauma, with the following being the most common:
• Breaks and fractures of the nasal bones
• Nasal obstruction or blockage caused by a foreign or unusual object
• Nosebleeds (Epistaxis)
• Chemical irritation
• Injuries or irritation to the inside of the nose
• Septal haematoma
Nasal Fractures And Complications
Nasal fractures account for almost 40% of all injuries involving the face. Not only will this damage the skin, bone, and tissue around the nose, but it can also lead to more severe issues. Don’t forget that if you have sustained a force that is sufficiently strong to break the nose, it could have caused some other collateral damage to nearby structures as well, and these must be looked out for.
Septal haematoma – This condition causes blood to collect within the lining of the septum. The blood then clots to stop the bleeding, forming a haematoma. If this condition is left untreated, it can prevent the cartilage from receiving sufficient nutrition and oxygen, causing it to weaken and eventually collapse. This can cause severe complications including a septal abscess, ascending cavernous sinus infections of the internal vessels of the brain (thankfully extremely rare!), necrosis of the septal cartilage, saddle deformity and septal perforation. Septal haematomas should be swiftly drained to prevent any issues. This will usually be performed under a general anaesthetic although a local anaesthetic is possible in some people.
Cerebral spinal fluid (CSF) Leak – CSF is a watery fluid that surrounds the brain within the skull. A leak of CSF is a potential complication that can occur after a skull injury and requires urgent attention. This can happen immediately or even a few days after a head injury, with the patient describing a watery discharge from the nose, usually from one side. A sample may be tested to determine if the fluid is indeed CSF (as there are many more common causes of a watery or runny nose such as nasal mucus). Treatment may vary from bed rest, hydration and saline infusions to surgical procedures.
Anosmia – this means a complete loss of the sense of smell (hyposmia means a partial loss of smell). This could be temporary or long-term. Treatment will depend on the direct cause and may not always be effective.
Septal deviation – A condition in which one air passage is smaller than the other due to displacement of the septum. This can be caused by head trauma and may cause further issues such as a blocked or congested nose, breathing difficulties, sleep disruption and nosebleeds.
Managing nasal trauma
A patient who has suffered complications following a nasal trauma should seek medical advice – whether attending A&E immediately (for more severe problems) or consulting a professional ENT consultant.
Depending on the nature of the trauma, advice and treatment may be successfully provided by a professional ENT consultant. You may also have some follow up appointments shortly after to ensure the recovery process is successful.
If there are no complications, and the only injury is the fracture to the nasal bones, it is usual practice to leave the nose for 5-7 days to allow any surface swelling to reduce, as the swelling can make it difficult to assess the precise degree of movement of the nasal bones underneath. You might therefore be asked to return to the clinic at that point. If the nasal bones are definitely out of place due to the injury, one option is for you to undergo a manipulation of the fractured nose (MUA). This is a simple procedure, undertaken under a general anaesthetic. It needs to be performed ideally within 14 days and if possible no more than 21 days from the date of the trauma, otherwise the nasal bones might have set in their new position by then, making a manipulation after this time point very difficult to move the bones back into position.
Sometimes, an MUA may not be successful, even if performed within the correct timeframe, or where there has been trauma previously to the nose, which can make it difficult to render the nasal bones perfectly straight. If this is the case, or if you are also suffering from a deviated nasal septum causing a blocked nose, you might benefit from a septorhinoplasty, which is a more formal operation aimed at resetting the nasal bones and nasal septum. It is usually performed several months after the index injury, once all swelling and healing from the injury have taken place, and is more successful at being able to straighten the nasal bones and septum as well as correct any other deformities or irregularities that might be present. The decision as to whether to proceed with septorhinoplasty surgery will be discussed in detail with you during the consultation.
For more information on the management of nasal trauma or on any of the ENT services we offer, please contact London ENT on 0203 865 7225 or firstname.lastname@example.org.