ACUTE NASAL TRAUMA:
Many difficult septorhinoplasties which are performed would not have been required if patients with fractured nasal bones had received immediate and efficient management. Fractured noses are usually managed incorrectly, because patients are dealt with in emergency rooms by junior doctors, reduced to pushing the nose into the middle by the thumb and finger or because the primary injury is neglected by the patient. Detailed management of nasal and facial fractures are out of the scope of this book. However, the basic principles are:
- To reduce the fracture once the oedema subsides by day seven to ten, or immediately after the fracture has occurred, before oedema starts to obscure and mask the shape of the fractured nose.
- Do not try to push the fractured or depressed nasal bones toward the middle, because this manoeuvre will cause more depression of the fragments of the fractured bone and in addition the depressed bone will prevent any return to the midline, so the
concave and convex nasal bones will shift into a more central position with preservation of the crooked shape. (Fig. 9 -14) - The first essential step is to do disimpaction. The depressed fragments are freed by elevating each nasal bone in turn (start with non-depressed bone then depressed bone) from within in an outwards direction. This is best achieved by Walsham’s
forceps. After disimpaction, light pressure is applied to each side of the nose in order to restore the normal contour. Ash’s forceps may be used to straighten the septum by applying forward and upward traction on the cartilagenous deviated septum. Steri-strips and plaster of paris are applied for seven days. (Fig. 17 – 6)