Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Definition: Fracture nasal bone (also known as Broken Nose) describes fracture of one of the bones of the nose and it is common due to many factors as described later.

Causes: Blow or accident.

Incidence: Common, due to nasal position and more common in males.

Pathology: 

Types depend on the direction & force of trauma:

Lateral trauma: fracture at the weakest point near suture line, resulting in lateral deviation.

Anteroposterior trauma: results in either:

• Comminution: multiple fractured bone fragments.
• Flaring of both nasal bones over the frontal process of maxilla.
• Telescoping of the nasal bone into the ethmoidal labyrinth, this may be associated with CSF rhinorrhea.

Symptoms of Fracture Nasal Bone

• History of trauma
• Pain
• Swelling & deformity
• Nasal obstruction
• Epistaxis

Signs:

• Inspection: Swelling – deformity, edema.
• Palpation: Tenderness -Crepitus.
• Anterior rhinoscopy: septal hematoma, blood clots, mucosal lacerations.

Investigations:

• X ray nasal bones lateral view: important medicolegally.

Treatment of Nasal Bone Fracture:

• First: control epistaxis.

(A) If patient is seen shortly (within few hours) after trauma; no marked edema:

- Reduction by Walsham & Asch forceps.

- Fixation by nasal pack & external nasal splint.

(B) If there is marked edema:

Wait for 5-7 days; give antibiotics, anti-inflammatory till edema subsides, then reduction and fixation.

(C) If patient is seen late (after two weeks): 

There is malunion: rhinoplasty is scheduled 3-6 months after the incident of trauma.

• Give prophylactic antibiotics in all cases.

Key points:

The most important issues about nasal bone fracture are the timing of repair and the management of complications especially septal hematoma being the most common associated complication which may be missed if not looked for especially in comatosed patients.

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