Among facial injuries, injuries to the nose are the most common. This is due to the fact that this human organ has a fragile structure. Boys under 12 years of age are the leaders in developing this pathology. A nasal fracture is eliminated by repositioning the bones, but before you become familiar with this process, you should know what structure the nose has and what damage can occur.

A little anatomy

The nose is a pyramid-shaped hollow formation, with two nasal passages and a septum forming them. The lateral walls of the nose also have a base of cartilage, which goes into the bone frame of the skull.

Anatomical location of bones and cartilage:

• The outer or lateral wall contains the nasal and palatine bones, as well as the nasal surface of the upper jaw, the frontal process, the lacrimal ossicle, the ethmoid bone and the pterygoid processes of the main bone.
• Partition connecting the side walls.
• The perpendicular plate of the ethmoid bone and the vomer enter the posterosuperior part.
• The movable part of the septum and the quadrangular cartilage are located in the anteroinferior part.
• The upper wall consists of a thin cribriform plate that is easily damaged by injury.
• On the sides there are large and small wing cartilages.

When the nose is damaged, the outer bones are most often affected, less commonly the orbital walls, nasal turbinates, frontal processes and vomer.

Causes of injury and classification

A direct blow from a blunt or sharp object causes a fracture of the nose. The direction and force of the blow is of great importance in this injury.

• Side impact - the traumatic force falls on one of the side walls and its direction does not coincide with the longitudinal plane or is directed transversely to the nose. With such an impact, a fracture of the bones of the wall occurs with their depression inside the nasal passage, a fracture of the septum with the displacement of debris in the direction of the traumatic impact, and then a fracture of the opposite wall occurs in the same direction. And as a result - lateral deformation of the nose.
• Front to back. This blow falls on the anterior plane of the nose, and the direction of the force coincides with the longitudinal plane and a fracture of the nasal bone occurs in the area of ​​its own bone sutures and their connection with the nasal process of the frontal bone and maxillary bones, and a fracture of the vomer can occur. A “saddle-shaped” flattening of the nose appears at the site of damage.

The main injuries that most often cause a nasal fracture are:

• Sports.
• Production.
• Household.
• Fights.
• War damage.
• A nasal fracture can occur due to fainting or an epileptic attack.

This injury has several types, which depend on which bones are broken, whether there is displacement, the side of the injury and the presence of a wound.

• Open - there is a wound through which bone fragments are visible.
• Closed - the presence of only abrasions and swelling.
• With displacement - the nose is asymmetrical, there is a lateral or anteroposterior displacement.
• Impacted - one fragment penetrates another or injures the wall of the skull.
• Fracture of the nasal septum - the nose falls inward.

Depending on the side of the injury:

• unilateral fracture;
• bilateral fracture.

Often these injuries are combined with a head injury or fractures of the facial bones, disruption of the integrity of the skin and nasal mucosa. All this requires different and complex therapy methods involving doctors of different specialties.

Important! With such a fracture, you need to see a specialist. This is especially important if a child has been injured, since in the future the nose may not form correctly, which will lead to deformation of the nasal bones, difficulty breathing and ENT diseases.

Having studied what a fracture is, you should familiarize yourself with what symptoms may accompany this injury.

Symptoms

Nasal injury is always accompanied by severe pain, which intensifies with pressure or palpation during examination. The following signs also appear that indicate the need for surgical intervention:

• Swelling of the face and nasal mucosa.
• Difficulty breathing.
• Swelling of the outer part of the nose.
• Bruises in the nose and eye sockets.
• Copious nasal discharge of mucus.
• Bloody streaks appear in the eyeballs.
• Nosebleed, complicated fracture.

In addition to the symptoms that occur during the first day after a fracture, body temperature may increase, redness in the area of ​​the fracture, and softening of the tissue. Such manifestations in the next day after injury indicate infection of the wound.

Similar symptoms can appear when the integrity of the cartilage is damaged, without damaging the bone. In this case, damage can be distinguished only after radiography.

First aid

In case of such damage, the victim must be provided with first aid:

• Sit the victim down and tilt his body and head forward. This will help prevent blood from entering the airways.
• Apply a cold compress to the bridge of your nose.
• If blood continues to flow out, gauze pads soaked in water are inserted into the nostrils.
• The patient should be taken to the emergency room.

Important! If a fracture of the base of the skull is suspected, the patient should not be touched, but a medical team must be called. His pulse and breathing should be monitored until the ambulance arrives. Also, with this injury, it is prohibited to forcefully feel the nose or try to correct it.

Diagnostics

How to fix a broken nose? Before correction of the injury begins, a specialist makes a diagnosis. To do this, the traumatologist examines and palpates the nose, and the ENT doctor examines the patient’s nasal cavity using a rhinoscope. This is necessary to assess the condition of the nasal cavity, nasal passages and the condition of the septum. Often, upon examination, blood clots are found in the nasal cavity.

If there is a wound in the nasal area, the doctor will place a metal probe into it and check whether it connects to the nasal cavity.

Instrumental examination consists of:

• Radiography. The picture is taken in two projections - full face and profile. Rarely a different projection may be needed. The resulting image will show all the fracture lines, the number of fragments, and the presence of displacement. X-rays can detect damage to the bones of the skull.
• CT scan of the nose and skull. This examination provides more accurate indicators and will reveal the location of fracture lines, the number and location of fragments, the general condition of the nasal cavity, its paranasal sinuses, and detect damage to the bones of the skull and other structures.
• MRI is used in situations where there is a need to obtain additional information about damage to the skull and other anatomical structures.
• Endoscopy. With its help, you can assess the condition of the nasal cavity, mucous membrane of the nasal turbinates, and paranasal sinuses.
  The main advantage of nasal endoscopy is that the specialist can examine anatomical structures that previously could only be seen during surgery.

After diagnosis, the doctor prescribes treatment.

Treatment

Nasal repositioning is not only cosmetic in nature, allowing to restore the patient’s appearance, but also helps to correct the pathology of nasal functions. During surgery, the specialist connects the fragments of the nasal bones, which promotes their rapid and proper fusion.

If the damage is not accompanied by displacement, then the doctor simply treats abrasions and wounds on the skin, excises the damaged tissue and applies sutures. After this, the patient is administered antitetanus serum.

If there is displacement, the doctor returns all the fragments to their place. This procedure is called repositioning of nasal debris.

How is this procedure carried out? How many operation methods are there? What possible risks may arise?

• It is best to carry out reposition immediately after injury, before severe swelling occurs. Maximum period is three weeks. If much more time has passed, then the nasal deformity will have to be corrected through surgery. If a concussion is detected in the victim, the reduction is postponed for 5–6 days.
• The nose is straightened with the patient lying or sitting.
• The operation is performed under local anesthesia.
• If there is a lateral displacement, the doctor eliminates it using finger pressure. If the displacement is anteroposterior, then the specialist inserts a special metal instrument – ​​an elevator – into the victim’s nose. With its help, wielding it like a lever, he returns the fragments to their anatomical place.
• After repositioning the nasal bones, gauze swabs soaked in an antibiotic solution are inserted into the nostrils. Turundas will help prevent debris from moving. Sometimes they are impregnated with paraffin for better fixation. The patient needs to wear them for a week, changing them every two days. Also, after reposition, special splints are used, which are applied to the outside of the nose. They are worn for 12 – 14 days.

In case of numerous fractures and large deformation of the nose, the shape cannot be completely restored during reduction. In this case, plastic surgery is performed six months after the injury. During plastic surgery, the surgeon corrects the shape of the nasal septum and the nose itself. After this, the nose is immobilized with a special splint or a plaster cast is applied, which should be worn for fourteen days.

Anesthesia is used if there is a fracture of the nasal septum. This operation is much more complicated and may require implants.

If a hematoma appears on the nasal septum, it is immediately drained to avoid possible complications in the form of necrosis of cartilage tissue.

Rehabilitation

When repositioning the nasal bones after injury, to prevent the development of negative consequences, patients must follow the doctor’s recommendations.

• The victim should avoid any traumatic injury to the nose and the entire nasal cavity.
• Refrain from intense physical activity.
• Stop wearing glasses for a while.
• Use nasal vasoconstrictors to facilitate nasal breathing only as prescribed by a doctor.
• Avoid taking hot baths and visiting baths and saunas for a while.

Depending on the patient’s condition, the type of injury and the complexity of the surgical intervention, the applied plaster cast is removed after a few weeks - one or two. After removing the plaster and tampons, if there is no infectious process, the recovery period can be accelerated with the help of physiotherapy. This course of treatment consists of the following procedures:

• Infrared irradiation. With its help, blood circulation is increased at the site of injury, which accelerates recovery processes.
• Electrophoresis. Using a locally directed electric field, healing, analgesic, and anti-inflammatory substances are delivered to the site of injury.
• UHF allows you to speed up healing and reduce pain.

Consequences

If a nose injury occurs and the victim does not take the necessary measures regarding this, then negative complications and consequences may appear:

• A hematoma of the nasal septum occurs. Without its timely removal, cartilage necrosis may occur. The hematoma is excised surgically.
• Incorrect fusion of the nasal bone occurs, which leads to a pronounced cosmetic defect.
• If deformation of the inner nose occurs, the person loses his sense of smell and has breathing problems. These pathologies provoke ailments such as trigeminal neuralgia, migraine, and asthma. Narrowing of the tear ducts and paranasal sinuses, which can cause chronic diseases of the nose and eyes.

Repositioning of the nasal bones is a surgical intervention necessary for nasal injuries accompanied by a violation of the integrity of the bones. It is necessary to realign the nose after a fracture for the first 24 hours after the fracture, since only in this case doctors guarantee a favorable result of the realignment and a minimal risk of developing possible negative complications.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!

In traumatology, approximately 3-3.5% of the total number of dislocations are injuries to the temporomandibular joint, when the articular head is displaced from its main position. If such a nuisance suddenly occurs, it is important to know what needs to be done before medical help, how to straighten the jaw and whether it can be done on your own, as well as how to prevent displacement and sprains in the future.

Causes of dislocation of the upper or lower jaw

The most common cause of spontaneous dislocation is strong opening of the mouth when yawning, screaming, laughing, or trying to cope with too large a piece of food. In addition, the problem can be triggered by certain medical operations and manipulations - in particular, dental treatment, gastroscopy or swallowing a probe to examine the stomach.

In rare cases, attempts to crack a hard nut or open a bottle or any packaging with your teeth can lead to this condition. The risk group includes people who have:

Another medical cause of dislocation is a congenital pathology of the development of the jaw joint, as a result of displacement of the connective tissue.

Species

There are several types of jaw dislocation, in which the articular head is located differently:

• anterior with the head placed in front of the recess;
• posterior, characterized by the location of the articular head directly behind the joint capsule;
• lateral - at a small distance from the hole.

There are dislocations:

1. unilateral, characterized by pain occurring on either the left or right side;
2. bilateral, in which displacement and pain are felt on both sides.

Depending on the time and frequency of occurrence, sprains can be primary or chronic.

The most complex condition is one in which additional ruptures of connective or articular tissues occur.

Symptoms

There are several signs that allow you to accurately determine a dislocated jaw even before providing medical assistance.

Common symptoms include:

• pain occurs at the slightest attempt to move the displaced joint;
• increased salivation;
• inability to move the jaw.

If anterior simultaneous displacement of both sides of the lower jaw occurs, speech becomes unintelligible, pain spreads to the ear area, and it is impossible to close the mouth.

Unilateral damage is characterized by a concentration of the listed symptoms on the left or right. However, both parts of the mouth close.

Posterior dislocation is characterized by bringing both jaws together, making it impossible to open the mouth. Moreover, in a supine position, the affected person may begin to choke. In this case, the teeth from the lower row sometimes shift back, towards the throat. Other signs include pain and swelling in the area under the ears.

The main symptoms of a lateral dislocation include slurred speech, jaw shifting to the right or left side, and pain and swelling around the injured joint.

It is important to be able to distinguish between a dislocation and a subluxation. The symptoms of both conditions are very similar, but with subluxation the lower jaw remains slightly mobile, and the pain is not so severe. In this case, a characteristic clicking sound may be heard at the site of displacement. In most cases, the mouth remains closed in case of subluxation. The only exception is bilateral anterior subluxation.

What to do and which doctor to go to

When a jaw is dislocated, the injured person requires urgent medical care to ensure qualified and most effective treatment. But before applying, first aid must be provided.

If severe pain occurs, it is necessary to eliminate it with the help of painkillers, and then take care to limit movement.

After this, you need to use a scarf or bandage to secure the mouth and go to a qualified maxillofacial surgeon who will perform all the necessary procedures.

How to straighten your jaw: algorithm of actions

There are several effective ways to straighten a broken jaw joint.

Depending on the type of jaw displacement, a conservative or surgical method is used.

At the initial stage of treatment for dislocations of any type, a conservative method is used. Its essence is to realign the displaced head of the jaw joint into the groove.

At the end of the procedure, the joint is fixed in the optimal position using bandages or special splints. You must stay in this position for at least 10-14 days.

Surgical treatment is used only in cases where it is necessary to straighten the jaw as a result of its repeated displacement. It is based on the formation of new or restoration of old ligaments.

Doctors reset dislocated jaw joints in several ways, such as:

• Hippocratic method;
• Blekhman-Gershuni method;
• Popescu's reception.

The most common is the first method, which involves the following algorithm of actions:

• The patient sits in a low chair, resting the back of his head against the back or pillow. In this position, the displaced jaw should correspond to the level of the doctor’s elbows.
• The doctor, wrapping his thumbs in a thick cloth, places them on the lower molars, and covers the lower jaw with all the rest.
• In this position, the surgeon begins to apply measured pressure with his fingers in an up and down direction.
• With a gentle push, he returns the jaw to its natural position. At this stage, a characteristic clicking sound should be heard, after which the jaws can close.

The Blechman-Gershuny method can be implemented using two options:

1. The doctor determines the location of the displaced areas of the jaw joint and simultaneously moves them up and down. As a result, the joint is installed in its place.
2. It is carried out by external influence - the least uncomfortable and the fastest. Having identified the displaced coronoid processes of the joint, the doctor moves them back and downwards with careful movements.

Particular attention is required for chronic anterior dislocation, in which all the methods considered are ineffective or even undesirable. In such cases, the Popescu method is used exclusively. The steps of this procedure are:

• local anesthesia is performed;
• the patient is placed in a horizontal position;
• bandage rollers with a diameter of 1.5 cm are placed in the oral cavity;
• the doctor presses the chin up and back with force, after which the joint will return to its natural position.

At home, you can perform jaw reduction only using the Blechman-Gershuny method. It is the least dangerous and is easy to learn.

Does it hurt to straighten your jaw?

Jaw realignment procedures are completely painless, as they are performed under local anesthesia.

What is the price

In dental clinics, the cost of a jaw realignment procedure varies from 600 to 3,000 rubles.

Treatment after reduction

After performing manipulations to straighten the jaw joint, it is necessary to securely fix the jaw using a bandage, splint or Petrosov apparatus. You need to spend two to three weeks in this position.

Pain may persist for some time after the procedure, so to eliminate it it is recommended to take ibuprofen, diclofenac, ketorolac or other drugs from the category of non-steroidal anti-inflammatory drugs.

Such medications not only relieve pain, but also perform other useful functions - they reduce the inflammatory process and swelling of surrounding tissues.

To ensure that the rehabilitation period is as effective as possible and does not drag on for too long, you must follow the recommendations:

• refrain from eating too hard and dense foods for two weeks, as it can provoke re-dislocation;
• talk and yawn very carefully.

To prevent jaw dislocations, you must continue to be careful when eating, brushing your teeth and vocal exercises, and also avoid injuries to the jaw joint.

Only a highly qualified doctor - an oral and maxillofacial surgeon - should straighten a jaw that is dislocated or displaced. Before contacting the clinic, it is necessary to ensure fixation of the jaw and relieve pain. After medical procedures, a recovery period of two to three weeks will be required.

Source: zubki2.ru

It is considered the most common. Such an injury provokes a violation of the olfactory and respiratory systems. Most often, this condition occurs in everyday life: when falling on slippery ice, floor, or during a fight. But there are also people who are at risk because of their professional activities - athletes and motorists. To restore the condition of the organ and realign the bones, a repositioning procedure is used.

Structure of the nasal cavity

To determine exactly what a fracture is and how to set a broken nose, it is important to know its structure. This organ borders the skull in the upper region, the mouth in the lower region, and the eye sockets on the side. And the structure of its cartilage and bones is the following diagram:

1. The outer wall, also called the lateral wall, includes the nasal and palatine bones, the nasal surface of the maxilla, the ethmoid bone, the frontal process, the pterygoid processes of the main bone and the lacrimal ossicle.
2. The side walls are connected by a special partition.
3. The posterior upper part consists of a vomer and a perpendicular plate of the ethmoid bone.
4. In the anterior lower part there is a quadrangular cartilage and a movable part of the septum.
5. The upper wall includes a cribriform plate, which is easily deformed at the time of injury.
6. In the lateral part of the nose there are large and small alar cartilages.

In most cases, doctors are faced with trauma to the external bones of the nose. Very rarely, damage occurs to the orbital walls, vomer, and frontal processes. It is possible to set a broken nose only in the near future after receiving the injury.

Main symptoms of a broken nose

All nasal cartilages are quite easily injured, as they are fragile. The first symptoms of a fracture will directly depend on the type of injury, as well as under what circumstances and how exactly it was caused.

Common signs of a fracture include bone damage and severe displacement of the nasal bridge. If the injury is not severe, then external signs of bone damage are not visible. In this case, the presence of a fracture can only be detected through an X-ray examination or computed tomography. And if it occurs only in cartilage, then the integrity of the bones may remain in normal condition.

If characteristic crunching sounds are heard during palpation of the nose, this indicates the exact presence of damage. But in this condition, the patient is prohibited from independently pressing hard on the nose, palpating it, or performing any mechanical actions on it in order to determine the friction of one bone against another. This procedure can only be carried out by the attending physician, otherwise the patient will only worsen his condition and provoke complications.

The main signs of injury include the appearance of swelling in the area of ​​the nose and eyes, the formation of hematomas at the site of impact, and bleeding. When pressing on the damaged area, the patient feels severe pain, nasal breathing becomes difficult, and the desire to blow his nose appears. Bloody streaks may appear in the eyeballs. In some cases, the patient's temperature rises.

What types of fractures are there?

Doctors divide all fractures into the following forms:

• closed - visible disturbances are minimally expressed (swelling and minor abrasions can be noticed);
• the open form is manifested by wounds on the skin in which bone fragments can be seen;
• fracture with subsequent displacement of the bone - in this condition, the shape of the nose changes, becomes asymmetrical (can occur against the background of external damage to the skin or have a closed shape);
• deformation of the nasal septum - the nose sinks inward.

It is important to know all the signs and symptoms of a fracture in order to see a doctor on time for diagnosis and initiation of effective treatment. In particular, timely contact with a specialist is required if a child has been injured, since in the future his nose may not form correctly, causing curvature of the organ, problems with respiratory activity and ENT diseases.

In addition to the first symptoms that appear on the first day after receiving a fracture, the patient, as already mentioned, may have an increase in body temperature. On the third day after injury, the wound may become infected with harmful bacteria.

Carrying out diagnostics

Before straightening the nose, doctors use the following diagnostic methods:

1. Rhinoscopy is used to identify areas of soft tissue rupture.
2. To understand whether there is a displacement of bones and cartilage, the patient is given an x-ray of the lateral part of the nose.
3. Inspect internal damage using an endoscope.
4. After this, the patient is prescribed urine and blood tests.

After carrying out diagnostic measures, the doctor draws up a treatment plan. Typically, it looks like this:

• First aid is provided in the form of applying a cold compress to the injured area, which helps get rid of swelling and relieve pain.
• In case of severe pain, the patient is given sedatives and painkillers.
• A tetanus vaccination is given.
• If during a fracture there is a shift in the bones or fragments appear in them, then reposition is prescribed.

Features of reposition

To straighten the nose, you can use reposition. The procedure should be carried out within a limited period of time - no more than 21 days should pass from the moment of injury to the reduction of the septum. The optimal time for surgery varies from 5 hours to one week. It is during this period that it is important to seek help from a doctor.

How is the nose set after a fracture? If the patient comes to the doctor immediately after receiving an injury, but he has severe swelling of the nose and nearby tissues, then the resection is postponed for several days until the condition of the soft tissues improves. But after the tenth day of the fracture, it is much more difficult to perform a reduction, since a bone callus begins to form in the affected area. In this case, the treating specialist will have to carry out the procedure using a special bandage.

Is it possible to straighten the nose after 3 weeks after receiving a fracture? No, repositioning is not possible. In this case, surgery is postponed for six months, during which the bone heals completely.

To get rid of abnormal fusion, you will need to perform a complex operation under general anesthesia. The specialist re-breaks the bone at the site of improper fusion and puts it in its correct natural position.

To straighten the nasal septum, the specialist will use a specific method in each case. This will determine how quickly and comfortably the treatment itself will take place.

When is reposition used?

Reposition is prescribed for the following types of nasal fracture:

1. When the back of the nose sinks - rhinolordosis.
2. If the nasal bone is set too far inward and looks too short or wide. This type of fracture is called platyrinia.
3. If the nose is displaced to the side - rhinoscoliosis.
4. When a hump forms on the nose after a fracture, it is called rhinokyphosis.

Carrying out treatment

If the patient has been prescribed reposition of the nasal bones, then all therapeutic measures will be divided into several stages:

• Preparation for surgery, during which the patient will undergo procedures to relieve pain shock and eliminate swelling in the diseased area, as well as in the sinuses and passages. To get rid of bleeding, tamponade is performed.
• Setting your nose only hurts if you don't inject anesthesia. Therefore, the area is numbed. It is carried out by administering anesthesia with a syringe or by lubricating the fracture site with a special drug with an analgesic effect.
• Reposition is carried out manually or using elevators. If there are no elevators, then instead of them, tweezers are used, the ends of which are wrapped with cloth, and a rubber pipe is put on top. The elevator is inserted into the nasal cavity, and from the outside the doctor works with his hands, carefully moving the bone and cartilage to its original position.
• If the bone structure is severely crumbled when a fracture occurs, then after surgery an additional tamponade is performed. Tampons soaked in paraffin are inserted into the nasal cavity in order to properly fuse the bones. Recovery time is most often 14 days.

When is anesthesia needed?

Anesthesia for reposition is used only if the fracture occurs on the nasal septum. This procedure is considered more complex and time-consuming; during it, the doctor may need to install implants in the nose. If a hematoma appears on the nasal septum, it is immediately eliminated. Otherwise, the patient may experience some complications, for example, necrosis

Among facial injuries, nasal fracture is the most common. This injury can result in damage to the olfactory and respiratory functions. Usually this phenomenon occurs in everyday conditions: a fall on a slippery floor, ice, a fight, but there is also a risk group - people, including athletes and motorists. The procedure used to eliminate organ dysfunction due to a fracture is called repositioning of the nasal bones. To understand what a nasal fracture can be, you should know about its structure. The nose borders the skull at the top, the oral cavity at the bottom and the eye sockets at the sides.

Bones and cartilage are located as follows:

• The outer wall, also called the lateral wall, includes the nasal bone, palatine bone, nasal surface of the upper jaw, ethmoid bone, pterygoid processes of the main bone, frontal process and lacrimal ossicle.
• The side walls are connected by a partition.
• The posterosuperior part includes the vomer and the perpendicular plate of the ethmoid bone.
• In front below there is a quadrangular cartilage and a movable part of the septum.
• The upper wall is formed by a thin cribriform plate, which is easily damaged by injury.
• On the side of the nose are the large and small alar cartilages.

Most often we can deal with injuries in the external nasal bones; injuries to the walls of the orbits, vomer, frontal processes and nasal turbinates are rare.

What are the types of bone fractures?

• Closed form - visible manifestations are mild (abrasions and swelling).
• The open form is characterized by wounds on the skin, bone fragments can be seen.
• With displacement - the nose becomes asymmetrical (may be accompanied by external damage to the skin or have the characteristics of a closed shape).
• Damage to the nasal septum - the nose falls inward.

It is necessary to know the symptoms of a nasal fracture in order to consult a specialist for treatment in time. This is especially important if the injury occurred in a child, since in the future the nose may not form correctly, leading to curvature of the organ, difficulty breathing and ENT diseases.

How to recognize a broken nose:

• blood flows (there may be either copious or scanty discharge);
• shock and loss of consciousness are possible;
• the skin around the nose, eyes and cheekbones becomes swollen;
• red veins are visible in the eyeballs;
• difficult to breathe, frequent blowing of the nose;
• there are wounds, sometimes fragments are visible;
• the nose hurts, touching it causes acute pain;
• bruises appeared at the site of injury and under the eyes.

In addition to the primary signs that appear during the first day after a fracture, there may be an increase in temperature, redness at the fracture site, and softening of the tissue. Such manifestations on the second or third day after injury indicate infection of the wounds by pathogenic microorganisms.

How is a nasal fracture diagnosed?

• using rhinoscopy, areas of soft tissue rupture are determined;
• to determine the presence of displacement, the patient is given an x-ray of the lateral part of the nose;
• Inspection of internal damage is carried out using an endoscope;
• The patient is prescribed laboratory tests of blood and urine.

After diagnosis, the doctor prescribes treatment that suits the individual case. Treatment options for nasal bone fractures are as follows:

• First aid involves applying a cold compress (ice) to the injured area to relieve swelling and reduce pain.
• For severe pain, the patient is given painkillers and sedatives.
• A tetanus vaccination is given.
• If the fracture causes the bones to move or crumble, reduction is performed.

Reposition of the nasal bones is carried out in a limited time. No more than 21 days should pass from the moment of injury to the bone realignment procedure. The optimal time for the operation is from 5 hours to 7 days.

If the patient comes immediately after the fracture, but there is severe swelling of the nose, then reposition is postponed for several days until the condition of the soft tissues normalizes. After the tenth day after the fracture, reduction is more difficult, as callus begins to form. In this case, the doctor is forced to secure the reduced area with a special bandage.

After three weeks after a nasal fracture, reduction is not possible. The operation is postponed for at least six months to allow the bones to heal completely.

In order to correct uneven fusion, a complex operation under general anesthesia is required. The doctor re-breaks the bones at the site of uneven fusion and puts them in the correct position.

Depending on the type of displaced fracture, the doctor chooses a method for setting the bones in place. How easy and fast the procedure will be depends on this.

There are several types of nasal fractures in which reduction is performed:

• When the nasal bridge is retracted, they speak of rhinolordosis.
• If the nose is strongly pressed inward and visually looks wide or short, then such a fracture is called platyrinia.
• If the nose is displaced to the side, then it is rhinoscliosis.
• The formation of a hump on the nose is called rhinokyphosis.

If the patient is indicated for repositioning of the nasal bones, the treatment includes several stages:

1. Preparation for surgery includes measures to relieve pain shock in the patient and eliminate swelling that forms in the nasal passages and sinuses. To stop bleeding, tamponade is done.
2. Anesthesia of the fracture site is carried out using local anesthesia by injecting medication with a syringe or irrigating (lubricating) the damaged part with an anesthetic.
3. Reposition is performed manually or using special elevators. If they are missing, then they are replaced with tweezers, the ends of which are wrapped with cloth, and a rubber tube is put on top. The elevator is placed in the nose, and from the outside the surgeon works with his fingers, moving the bones into place.
4. If the fracture is characterized by many bone fragments, then tamponade is performed after surgery. Paraffin-impregnated tampons are placed in the nasal cavity to ensure that the bones heal correctly. The recovery period with tamponade usually takes just over a week.

Anesthesia for reposition is used in case of a fracture of the nasal septum. This operation is more complicated; during it, implantation of implants into the nose is not excluded. If a hematoma occurs on the nasal septum, it is immediately drained. Otherwise, complications are likely to occur, such as necrosis of cartilage tissue.

In what cases is the patient hospitalized:

• severe external deformation of the nose;
• heavy or recurrent bleeding;
• complicated fracture with damage to the eye sockets, brain, and sinuses.

During the restoration of the nose after reposition, the patient should follow certain rules:

• It is prohibited to visit the bathhouse or sauna.
• You can't wear glasses.
• Situations where a blow to the nose may occur should be avoided, such as sporting events or playing ball.
• Avoid physical activity.
• If breathing is difficult as a result of swelling, vasoconstrictor drops should be used.

If the necessary measures are not taken in relation to a broken nose, negative consequences may occur.

• A hematoma of the nasal septum forms. If it is not removed in a timely manner, necrosis (destruction) of the cartilage is possible. The hematoma is removed surgically.
• The bones of the nose grow together crookedly, leaving a pronounced cosmetic defect.
• Deformation of the inner nose contributes to loss of smell and breathing problems. These ailments, in turn, give rise to common ailments: trigeminal neuralgia, migraine, asthma and others. Stenosis of the input ducts (tear duct, paranasal sinuses) can cause chronic diseases of the nose and eyes.

Straightening the nose after a fracture: effective techniques

To effectively realign the nasal bones, the location of damage and the condition of the body as a whole should be diagnosed as accurately as possible. Injuries to the nose result in swelling and bleeding. It is advisable to relieve these symptoms before repositioning. Often the patient has a concussion. In this case, the operation is postponed for several days until the patient’s condition improves.

For children, injuries with retraction of the bridge of the nose without bone fractures are typical. This is due to the age-related characteristics of bone tissue, which contains more elastic fibers than in an adult. But in this case, an operation is also performed to restore the normal position of the nasal septum.

The optimal time for realignment of the nose is the first few days after injury. If a patient has a displaced fracture of the nasal bones, treatment is performed before repositioning. The sooner the doctor sees the patient, the faster the fracture can be diagnosed, prepared for surgery, and the bones can be realigned. If the patient consults a doctor after a day or two, then severe swelling, emphysema, inflammation of the wound and other phenomena make diagnosis difficult and sometimes impossible. In this case, you have to wait until the condition of the soft tissues returns to normal.

Treatment of displaced nasal bone fracture

1. If there is heavy bleeding, tamponade is done. It is advisable to perform it after diagnosing a fracture; if the displacements are insignificant, then, in addition to stopping the bleeding, the procedure can help set the bones. At the same time, the doctor makes sure that this procedure does not cause further harm, which is possible in inept hands. If a tampon or turunda is inserted roughly, then damage to soft tissues and separation of bone fragments is possible.
2. Tamponade is made with tampons or long turundas, which are placed on top of each other. Tampons are soaked in cocaine-adrenaline and inserted into the nasal passages. The procedure is performed 2-3 times a day for 1-3 days.
3. If the fracture is open, the doctor treats the open wound with a solution of hydrogen peroxide or saline, cleaning it from dirt, sand, and blood clots. Individual bone fragments that are not connected are removed. They try to leave even the smallest fragments, if they have even a weak connection with soft tissues.
4. After washing the wound, the doctor assesses its condition and, if it is fresh and not inflamed, then stitches it up. If an infection gets into the wound, especially if there is purulent contents, the wound is left open for treatment. The patient is prescribed antibiotics, and the damaged area is treated with antibacterial agents. Emphysema usually goes away on its own after a few days.
5. If a hematoma of the nasal septum forms, the doctor removes it surgically.

Effective straightening of the nose after a fracture

1. To perform the operation, the doctor places the patient on the couch. This is done to prevent the patient from falling in case of shock. The operation lasts a few seconds, but is accompanied by severe pain.
2. The nasal mucosa is treated with a solution of cocaine and adrenaline, and an additional injection of novocaine is given under the skin. In case of complex fractures, general anesthesia may be recommended for adults and children to realign the nose.
3. Once the painkiller has taken effect, the doctor straightens the nose with his fingers and, if necessary, uses an elevator. At the time of the operation, the patient hears the crunch of the bone falling into place. The doctor’s actions to straighten the nose after a fracture differ, depending on the nature of the injury.
   • Nasal fracture with displacement to the side. The surgeon straightens the nose in this situation by moving his thumbs, pressing on the bone that has been displaced. The main thing here is to accurately determine the point on which you need to influence. If the retraction occurs on only one side, the doctor inserts an elevator into the nasal cavity and pushes out the bone fragment.
   • Recession of the nasal bridge. Nasal reconstruction surgery is sometimes performed with the fingers, but more often elevators are used. To do this, two instruments inserted into the nasal passages lift the bone (moving forward and upward).
   • Reduction of fragments. For this procedure, a nasal dilator and gauze pads with petroleum jelly are used. In order to set the fragments, the doctor inserts a dilator into the patient’s nasal passage and, gradually pushing its ends apart, sets the fragments in place. Then, without removing the dilator, he inserts turundas into the nose, securing the result.
   • Complex fracture with displacement and fragments. First, the fragments are set in the manner described, and then the displacement of the nose is corrected in one way or another.
4. Straightening a nose damaged as a result of a fracture often does not require external fixators. But sometimes their use is advisable. For example, with a small-fragmentation fracture, the bones do not hold together and are fixed by applying plaster or fixing rollers.

Repositioning of the nasal bones should be entrusted to experienced surgeons, especially if more than a week has passed since the fracture. After some time, thanks to qualified help, you can forget about the nose injury. But sometimes, after the swelling subsides, the patient observes a deterioration in the appearance of the nose. In this case, the patient is prescribed rhinoplasty, which will eliminate visible defects. When there is a deviated nasal septum, septoplasty is performed.

Straightening your nose after a fracture can be done either for a fee or free of charge. Many medical centers offer nasal repositioning services. Prices for this service vary from 2 to 40 thousand rubles. The final price depends on the complexity of the fracture, methods of examination and surgery, time spent in hospital, the cost of consulting a doctor, and so on. The free operation is performed in city municipal hospitals.

Comparative overview of prices for repositioning in some cities:

• Moscow - from 2500 rub. (finger), from 5000 rub. (instrumental);
• Ufa - 2000 rub. (excluding anesthesia), 3500 rub. (with fixation on a tampon);
• Tula - from 3000 rub. (finger) from 5800 rub. (instrumental);
• Ekaterinburg - from 1500 rubles;
• Astana - 4000 tenge.

Sometimes situations arise associated with traumatic exposure that require medical manipulation called coccyx reduction.

When to adjust your tailbone

Reposition of fragments in a fresh fracture is performed in a similar way, the procedure is similar to that described above.

Reduction of the coccyx for old injuries

Stale injuries of the sacrococcygeal region (6 months or more from the moment of traumatic impact) doctors try to treat conservatively; in case of severe pain syndrome, anti-inflammatory drugs and analgesics are prescribed, central muscle relaxants (Tolperisone, Sirdalud), it is possible to carry out novocaine blockades and blockades with hydrocortisone (or other corticosteroids).

Reduction of an old dislocation/subluxation is not performed due to the fact that the ligaments that strengthen the sacrococcygeal joint are stretched and are unable to hold the articular surfaces in a normal relationship, and it is anatomically impossible to fix them for a certain period of time. In addition, when trying to correct an old dislocation, additional damage to the ligamentous apparatus of the sacrococcygeal joint and the occurrence of pain are possible. A stale coccyx fracture is also managed conservatively for the following reasons:

1. The formation of the callus is complete, so fusion of the fragments is already a fait accompli.
2. If fusion does not occur, then a “false joint” has formed, so it is easier to perform resection () than to straighten and juxtapose the fragments.

If there is no effect from conservative management of a patient with chronic injuries of the sacrococcygeal region and severe pain with impaired quality of life, coccygectomy (resection of the coccyx) is recommended.

Is it possible to straighten the tailbone yourself?

You should not adjust your tailbone yourself without a medical education. This can lead to even more injury.

1. In case of an acute injury to the coccyx, the pain syndrome is strong enough for the victim to perform manipulations (editing) without anesthesia.
2. It is impossible to correctly put the fragments in place or reduce the dislocation without the participation of both hands, which is impossible to do on your own.
3. If you try to independently return the tailbone to its place in the event of a dislocation, you can further damage the sacrococcygeal ligaments, the healing and regeneration of which will occur slowly. Subsequently, development is possible.
4. When you try to independently compare fragments of a fracture (return them to their place) with sharp edges, there is a high probability of damage to the wall of the rectum, which can lead to infection of the perirectal tissue, the formation of paraproctitis.
5. Based on the intensity of the pain syndrome, it is impossible to determine which particular injury to the sacrococcygeal region causes pain: there are no specific complaints characteristic only for its dislocation and/or only for its fracture.
6. After performing manipulations to correct a dislocation or reposition fragments, the traumatologist must carry out X-ray control; after independent manipulations, this is not performed. Consequently, it is impossible to say about any control after self-reduction or comparison of fragments; healing may not proceed correctly, which often leads to the development of coccydynia.