Most nasal fractures cause vital injury. Correct techniques for treatment ought to be applied before any procedure and any definitive treatment of nasal fractures.
Choice of physiological state
Local physiological state
Closed reduction of nasal fractures is performed below local anesthesia within the majority of patients. The cavum ought to be ready with cotton pledgets moistened, with topical anesthetic and vasoconstrictive.
IV sedation is more for the comfort of the patient.
General physiological state
General anesthesia is a possibility in case of the surgeon’s and patient’s preference.
Reduction of Nasal Bones
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In laterally displaced fractures
Commonly laterally displaced fractures on one facet are medially depressed on the opposite facet. We are going to describe their treatment.
Place an instrument (e.g., Boies elevator) within the depressed facet on the lateral wall of the nose to some extent below the nasal frontal angle.
Place a finger on the lateral facet of the nose higher than the depressed space.
In centrally depressed fractures
Sometimes the frontal processes of the maxillae area unit displaced laterally with the nasal bones compact within them.
Reduction needs elevation of the nasal bones anteriorly and position of the frontal processes medially.
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The elevator should not be inserted too way into the cavum.
In this case, the elevator is placed within the nose and lifts the nasal dorsal pyramid anteriorly, whereas at the same time the thumb and forefinger are placed between the pressure on the displaced frontal processes of the maxillae.
Reduction of septum
Grasp the septum with the blades of the instrument and gently manipulate the septum into correct alignment.
Centrally depressed fractures need posterior to anterior elevation which may typically be achieved by reducing the septum.
Splinting
Nasal Bones
After reduction, adhesive strips area unit placed over the skin of the nasal dorsum and also the nasal bones area unit splinted victimization an external splint that conforms to the patient’s nose. If the nasal bones are comminuted or lose, they must be supported with an intranasal packing that ought to be placed before putting the external splint.
Nasal septum
The septum is stabilized with splints or packs.
Removal of packing and splints
Hemostatic packs are removed once in twenty-four hours. Packs that are supporting the nasal bones are left in situ because the external splint is in situ. (Various surgeons leave these in situ from anyplace between 5-10 days).
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