FRACTURES OF THE NOSE
location of the nose makes it susceptible to injury by a wide variety of
causes. In fact, nasal fractures are more common than those of any other bone
in the body. Fractures of the nose usually result from a direct assault. As a
rule, no serious consequences re-sult, but the deformity that may follow often
gives rise to ob-struction of the nasal air passages and to facial
signs and symptoms of a nasal fracture are bleeding from the nose externally
and internally into the pharynx, swelling of the soft tissues adjacent to the
nose, and deformity.
nose is examined internally to rule out the possibility that the injury may be
complicated by a fracture of the nasal septum and a submucosal septal hematoma.
Because of the swelling and bleeding that occur with a nasal fracture, an
accurate diagnosis can be made only after the swelling subsides.
fluid draining from either nostril suggests a fracture of the cribriform plate
with leakage of cerebrospinal fluid. Because cerebrospinal fluid contains
glucose, it can readily be differenti-ated from nasal mucus by means of a
dipstick (Dextrostix). Usu-ally, careful inspection or palpation will disclose
any deviations of the bone or disruptions of the nasal cartilages. An x-ray may
re-veal displacement of the fractured bones and may help rule out extension of
the fracture into the skull.
a rule, bleeding is controlled with the use of cold compresses. The nose is
assessed for symmetry either before swelling has oc-curred or after it has
subsided. The patient is referred to a spe-cialist, usually 3 to 5 days after
the injury, to evaluate the need to realign the bones. Nasal fractures are
surgically reduced 7 to 10 days after the injury.
nurse instructs the patient to apply ice packs to the nose for 20 minutes four
times each day to decrease swelling. The patient who experiences bleeding from
the nose (epistaxis) because of in-jury or for unexplained reasons is usually
frightened and anxious. The packing inserted to stop the bleeding may be
uncomfortable and unpleasant, and obstruction of the nasal passages by the
pack-ing forces the patient to breathe through the mouth. This in turn causes
the oral mucous membranes to become dry. Mouth rinses will help to moisten the
mucous membranes and to reduce the odor and taste of dried blood in the
oropharynx and nasopharynx.