1. The nose is located in the center of human head and face, which is a prominent part. In maxillofacial trauma, it is easy to cause nasal bone fracture Literature reports that nasal fractures after trauma account for 37% and 7% of facial fractures. The nose is a triangular cone protruding from the face, which is vulnerable to external injuries and fractures. Nasal bone, maxillary bone and frontal bone are the bones supporting the external nose, and the nasal septum plays a role in supporting the external nose. The frontal process of maxilla is connected with lateral nasal cartilage through tough connective tissue, which determines the width of nasal dorsum. Therefore, external forces with different strengths and directions acting on the nose are prone to nasal bone fractures, often accompanied by nasal septum fractures. The adjacent bone structure of nasal bone is mostly thin, and it is easy to form compound injury after fracture. For nasal bone fracture, if it is not diagnosed and treated in time, it will often lead to sequelae such as external nasal deformity, nasal septum deviation, nasal dysfunction (stuffy nose, headache, runny nose) and so on. Therefore, correct diagnosis, timely treatment and ideal recovery measures must be made after nasal trauma.
2. The common clinical nasal bone fractures are divided into ① simple nasal bone fractures, including unilateral nasal bone fractures, bilateral nasal bone fractures, nasal bone fractures with nasal suture separation; ② Compound nasal bone fracture, including nasal bone fracture with nasal septum fracture, nasal bone fracture with maxillary frontal process fracture, nasal bone fracture with orbital fracture, etc. According to the direction of fracture line, it can be divided into transverse fracture, oblique fracture and comminuted fracture.
3. Common symptoms and signs of nasal bone fracture: nosebleed, nasal swelling, eyelid bruising, nasal congestion, soft tissue tearing and different degrees of extranasal deformities (collapse under the bridge of the nose, nose back subsidence, etc.). The palpation of the nose is also very important. If palpation finds distorted pronunciation, tenderness, shortened nose or widened nose root, it all indicates the existence of nasal bone fracture. For patients with severe combined injuries, there may be serious complications: headache, vomiting, disturbance of consciousness, cerebrospinal fluid rhinorrhea, craniocerebral trauma such as skull fracture, maxillofacial bone fracture, limbs, trunk and spine fracture, etc.
4. Treatment In order to avoid sequelae such as external nasal deformity and nasal dysfunction, nasal bone fracture should be reset as soon as possible. Patients with stable vital signs and generally good condition should strive for early reduction of fracture, preferably within 2 ~ 3 hours after trauma. If the local swelling is obviously accompanied by nasal bleeding, it can last for 5 ~ 10 days, but it should not exceed 14 days, otherwise dislocation healing will occur due to callus formation and the repair will be unsatisfactory. The healing process of fracture can be divided into three stages: the evolution of hematoma, the formation of original callus and the transformation and shaping of callus. It takes about 2 weeks to complete the evolution of hematoma. The nasal bone fracture has not been reduced for more than 2 weeks, and callus has formed at the fracture site. Those who have difficulty in reduction are classified as old fractures.
The main treatment methods are simple nasal bone fracture reduction, nasal endoscopic nasal bone fracture reduction and old nasal bone fracture reduction.
5. The evaluation of general curative effect is mainly based on the appearance and ventilation of nasal cavity. Cure: the nasal cavity is well ventilated, the external nose is not deformed, and the nasal septum is basically in the middle; Improvement: the external nose is still slightly skewed or collapsed, and the nasal septum is slightly deviated, but it is better than before treatment, and the nasal ventilation function is obviously improved; Ineffective: the appearance of the nose is obviously deformed, the nasal bone fracture and displacement and nasal septum deviation have not improved after operation, and there are still symptoms of poor ventilation.