IF SYMPTOMS PERSIST
By DR. JOSE PUJALTE JR.
“I never thrust my nose into other men’s porridge.
It is no bread and butter of mine; every man for himself, and God for us all.”
— Miguel de Cervantes Saavedra (1547-1616), Spanish novelist,
Don Quixote. Part i. Book. iii. Chap. xi.
Dr. Jose Pujalte Jr.
A broken nose, properly called a nasal bone fracture, is as common as tonight’s bar brawl.
In facial trauma, it comprises 40% of bone injuries. It may or may not need surgery but treatment is necessary at the ER at least, to stop nose bleeding and to check if there are far more serious injuries like a broken neck or head trauma.
Signs and Symptoms. MayoClinic.com lists the following:
- Pain or tenderness on or around the nose.
- Bleeding from the nose (epistaxis).
- Bruising around nose and eyes.
- Crooked nose.
- Breathing difficult from the nose.
- Mucous discharge from nose.
- Feeling that the nasal passages are blocked.
ER Visit. Current recommendations no longer include a routine x-ray. What is necessary though is a thorough physical examination that starts with an anesthetic spray or local anesthesia. This makes you more comfortable and the doctor has more room to examine you without a reflexive head-butt. The doctor may then decide to manually reduce the broken nose once the swelling subsides (usually in 3 to 5 days). If undisplaced, no manipulation is done. Septal hematoma is managed emergently because blood has accumulated between the nose cartilage and perichondrium. If untreated, the cartilage dies, resulting in a saddle nose deformity. A septal hematoma is drained under local anesthesia.
WOF stands for Watch Out For. Usually, these are the final words of an outgoing doctor to the one coming in for duty. And it’s a litany of what can go wrong with a patient! In the context of a seemingly benign broken nose, WOF these 3:
- Clear fluid dripping from the nose – that may well be CSF or cerebro-spinal fluid rhinorrhea so that isn’t just a broken nose at all but a complicated injury that connects with the brain. If untreated, the brain covering can get infected, resulting in bacterial meningitis.
- Abnormal eye movements – may mean additional fractures of facial bones that support the eyeballs.
- Malocclusion – is a mal-alignment of the two dental arches and in this context, you may have not just broken your nose, you may have a broken jaw too.
Prevention. Of course, not just assault results in a broken nose, you can walk right into a clear glass door or hit your nose on a protruding pipe. Facial trauma is common in vehicular crashes.
Prevention thus includes wearing your seatbelt, wearing a helmet (for cyclists and motorcyclists), and using protective face equipment in sports such as martial arts and other contact sports.
For the most part, a broken nose just means a broken ego. After the humiliation, a timely visit to the ENT (ear-nose-throat doctor or otorhinolaryngologist or plastic surgeon is still the right thing to do.
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