Therapy of a broken nose
Treatment of the nasal bone fracture
Primarily the most important thing in the therapy of a nasal bone fracture is of course to treat the external wounds of the nose and its surroundings. If the nosebleed does not stop on its own, it is necessary to insert a nasal packing into the patient, which is supposed to stop the bleeding.
At nasal fractures not displaced Therapy is usually not necessary as the individual parts of the nasal bone grow back together correctly even without treatment.
However, if one or more bone fragments have been moved, they must be repositioned so that there is no obstruction to nasal breathing and a permanent change in the shape of the nose can be prevented. Because of this, therapy should go through Reduction also within 8 to 10 days because otherwise it can happen that bone have grown firmly together in the wrong position.
The formal errors that can remain due to a not timely reduction include the so-called Saddle nose (which has a dent on the bridge of the nose) and the Crooked nose. Therapy takes place either in Local anesthesia or one General anesthesia in the form of a Intubation anesthesia.
Here, the bone elements are lifted with the help of an elevator (a Lifting instrument) from the inside of the nose and brought back into its correct position. Then the nose mostly by one Plaster splint, sometimes by one Metal rail fixed to ensure uncomplicated healing.
In some cases, a nasal packing is also used after the procedure in order to be able to catch post-bleeding directly (broken nose).
When a Septal hematoma or a pronounced Septal fracture with a postponement, a operative therapy take place, as especially bending of the nasal septum can cause relatively serious consequential damage.
The corresponding procedure is called septoplasty and is characterized by the fact that the Cartilage structures be carefully straightened in the nasal septum. After the operation, the nose must be splinted from the inside, which is usually done with the help of two plastic plates that "Splints" are called, which are sewn to the nasal septum from both sides to stabilize it.
These have to stay in the nose for about 5 to 7 days and are then removed by the doctor (Broken nose).
Broken nose in children
In children, if there is a broken nasal bone, treatment basically involves the same steps as in adults. To diagnose whether there is actually a broken nose, you can various clinical tests be performed. A broken nose can usually be seen through Pressure with your fingers move strongly. In addition, affected children complain of severe pain. In addition, a broken nasal bone is partly evident in children heavy bleeding from the nose.
After conducting a conversation between attending physician and the parents and subsequent clinical examination are usually X-rays carried out in different levels. In addition, a ophthalmological examination be performed. It is not uncommon for a broken nose to have the Walls of the eye socket are also broken. There is also the risk of injury to the eye. To carry out a Computed Tomography (short: CT) is mostly avoided in children due to the high radiation exposure.
The actual therapy of the nasal bone fracture in children is divided into conservative and surgical Activities. Immediately after the accident, the heavy bleeding be breastfed from the nose. Especially in children, nosebleeds can be enormous and must therefore be breastfed as quickly as possible. Cold editions are particularly suitable for this neck and on the forehead be created. The child should sit as upright as possible during hemostasis and tilt their head back slightly. In the case of heavy bleeding, tamponades can also be inserted into the nostrils.
If there is a broken nasal bone with not or only minimally displaced fragments No surgical intervention is necessary in children either. This type of nasal fracture is usually caused by the Applying a support bandage treated. In the case of unstable and / or strongly displaced nasal fractures, however, the therapy must go through surgical reduction respectively. The aim of the operation is to normalize the position of the nasal bone in children and to keep it stable afterwards. Surgical nasal correction should be done in children within one day of the accident respectively. The surgical therapy of the nasal bone fracture in children can theoretically under local anesthesia or in general anesthetic be performed. For small children, however, general anesthesia is usually used in everyday clinical practice.
During the operation, the attending physician tries to position the bone pieces, starting from the inside of the nose, in such a way that a natural nose shape arises. In many cases, however, it is necessary to make a small incision on the inside of the nose. In this way, especially broken fragments (there are many small pieces of bone) can be ideally repositioned. A broken nasal bone in children with additional involvement of the nasal septum must also be two fixing plastic foils be introduced.
During the surgical procedure you can additional bruises removed become. This way you can reduce the risk of Development of tissue necrosis (Tissue dies) and Inflammation of the cartilage be lowered. Immediately after the operation of the broken nose in children, a plaster cast or one rail be created. To avoid heavy bleeding, a Nasal packing inserted into the nostrils. In cases where the structures surrounding the nose are injured, additional measures must usually be taken.
After surgical treatment of the broken nose in children, it can be especially in the first few days severe swelling and / or bleeding come. If there is an increased nosebleed, a doctor should be consulted urgently. Swelling can go through careful cooling can be managed well. In addition, temporary sensory restrictions in the area of the nose can occur. In most cases, however, these disappear again after a few weeks. If children complain of pain after conservative or surgical nasal fracture therapy, so can light pain relievers how Paracetamol or Ibuprofen Tobe offered. Depending on the need, these preparations can be taken every five to six hours, adapted to the weight of the children. On taking aspirin should in children in general and in front everything urgent after an operation be waived.
In addition, after surgical nasal fracture therapy, care should be taken to ensure that the Nose not blown in the first week becomes. Also at Sneeze the children should the Open your mouth wide. A Increase in pressure inside the nose can negatively affect and / or increase the treatment outcome Secondary bleeding to lead. In addition, care should be taken that there is no external pressure on the straight nose. Affected children have to be careful not to get a nudge while playing.
The result of the Attempted repositioning let yourself only weeks to months judge after the broken nose in children. This is in there to justify that Swelling around the nose can linger a long time until it becomes one complete regression comes. In addition, it must be noted that this result is due to the fact that Children still growing have changed over the years. If necessary, can Corrective surgery after a few years become necessary.
Therapy with a mask
The Face masks for a broken nose can be used so that the fracture and wound heal well after treatment and are protected from further irritation. Usually the masks are made by Professional athletes used after a broken nose.
The masks are made in orthopedic shops.
In order to manufacture such masks, an orthopedic surgeon must first have a Impression of the parts of the nose and cheek do. The imprint will be off plaster made and especially the nose area is the most crucial. A film is usually placed over the eye protection eyes placed. Then plaster of paris is carefully placed on the face and pressed down. In order to ensure the patient's oxygen supply, a small hole is usually slit at mouth level. If the plaster of paris has now hardened, you have to adjust and shape the mask in detail. Various instruments are used to grate the mace and smooth out contours and edges. Places that require special protection receive an additional layer of plaster. The masks are mostly off plastic or Carbon manufactured. In the case of basketball athletes, transparent plastic is usually used, while handball players and soccer players prefer carbon. The carbon provides slightly better protection in the event of a head impact, which is particularly important in these sports.
Now the next step begins, which is "Deep drawing" is called. Be there First holes were drilled in the eye region. The mask will then start with Silicone grease coated. A plate made of malleable plastic is heated to around 150 degrees. When the plate has reached this temperature, the Plastic plate placed over the plaster model so that it can take its shape. There is also a vacuum suction device, which is inserted through the drill holes and pulls the plastic plate over the plaster model.
In a final step, the mask only has to be cut out and the patient finally tries on the mask. The production of a mask takes at least eight hours and includes five work steps.
Such However, custom-made masks are usually very expensive and will too not covered by health insurance. Usually they are worn and paid for by professional athletes.
But there are also special ones Medical supply stores Face masks for about 70 euroswhich, however, only in Standard sizes exist and are not custom-made for the respective face.
The use of a face mask for a broken nose is usually not necessary for non-athletes. For athletes, the mask is only worn so that one does not have to wait for the fracture and the wound to heal completely, but can continue doing sports and still be protected from renewed fractures and injuries.
Cost of therapy for a broken nose
The costs of therapy in the presence of a broken nose are usually borne by both the statutory as well as private health insurances. If the originally aesthetic facial image could not be restored even after the standard measures for treating the broken nose, some health insurance companies will take over one as a goodwill gesture additional cosmetic surgery. However, this is not the normal case and there is no obligation for the health insurers to assume the costs.
If the cause of the nasal fracture is in the Coverage areas of a regular accident insurance falls, it is obliged to bear the costs incurred. A broken nose that as part of a brawl arises, is covered by this rule in most cases locked out.
In the event of a nasal fracture through a fight through no fault of one's own, the Payment of compensation for pain and suffering be sued. The assumption of the treatment costs by the perpetrator is usually not enforced in court. In these cases, at least the normal treatment costs are borne by statutory or private health insurances. A subsequent aesthetic operation must be carried out by the person concerned but mostly paid for yourself become.