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Abstract: The patient was a 54-year-old female who came to our hospital with “left external nasal distortion and right nasal collapse”. The patient reported that she had been hit on the nose in a fight 5 days ago and did not care about it because there was not much bleeding. After CT+3D reconstruction of the nasal bone, the diagnosis of nasal bone fracture was confirmed. The nasal bone was repositioned and the nasal cavity was ventilated normally without any other discomfort.
Basic information】Female, 54 years old
Disease Type】Nasal bone fracture
Hospital】HuaiBei Mining General Hospital
Date of consultation】May 2022
Treatment plan】Surgical treatment (closed nasal bone fracture repositioning under nasal endoscopy) + anti-infection treatment (cefradine for injection)
Treatment period】5 days of hospitalization and follow-up after 1 week
Treatment effect】Nasal bone repositioning, normal nasal ventilation, no other discomfort
I. Initial consultation
Patient Ms. Li, who came to our hospital in May 2022, reported that she had an argument with someone 5 days ago and was hit by a fist on the nose. Later, the swelling of the external nose was obvious, but no pain was aggravated, so I did not care. Five days after the injury, the swelling of the external nose subsided and the nose was found to be crooked, so the patient came to our hospital urgently. At the interview, the patient was found to have no obvious swelling of the external nose, slight pressure pain, left nasal distortion and right nasal collapse.
II. Treatment history
Nasal bone fracture can lead to external nasal distortion, local collapse and even affect the function of the nasal cavity, which can seriously endanger health. At first, the patient was a bit apprehensive about the surgical treatment, but after the communication about the basic condition and the danger of nasal fracture, the patient expressed his willingness to undergo surgical treatment. After completing the relevant preoperative examination, the patient was given a closed nasal bone fracture repositioning operation under nasal endoscopy to correct the nasal deformity. Postoperatively, the nasal cavity was filled with an expansion sponge for 3 days and then removed. Postoperatively, the patient was given cefradine for anti-infection treatment to promote recovery.
III. Treatment results
After the nasal endoscopic closed nasal fracture repositioning, the patient’s misaligned nasal bone was repositioned. After the operation, the patient showed symptoms of swelling and pain in the external nose, but there was no local distortion or collapse, the appearance was normal, and the nasal cavity could be ventilated normally without bleeding. Five days after the operation, the swelling and pain of the nose gradually disappeared and the patient recovered well without other discomfort, so he was discharged from the hospital. Before discharge, the patient was instructed to follow up in 1 week. At the subsequent follow-up, the patient said that no nasal discomfort occurred and expressed satisfaction with the treatment effect.
IV. Notes
We are glad that the patient’s nasal fracture was repaired and the crooked nose was corrected after the surgical treatment. Patients need to be careful not to wear glasses and not to press the external nose with their hands for half a month after discharge, so as not to cause the bone scab to suffer damage again and cause the reset to fail. Be careful not to move too much and reduce the vibration of the nose to reduce the occurrence of bleeding. Avoid soaking in the bath, and do not wash your hair with hot water for a long time to avoid vasodilatation, which may cause nasal bleeding. Avoid spicy and stimulating food. Once the nasal cavity bleeds or spits blood from the mouth, or bruises the nose again, prompt medical consultation is required.
V. Personal insight
Even if the nasal trauma is not painful, it is necessary to consult and examine the patient in time, because the nasal fracture needs to be reset within 10 days, and the fracture will produce bone scab in more than 10 days, which will cause great damage and make the reset difficult. In this case, although the nasal appearance was not abnormal and no bleeding or nasal congestion occurred in the nasal cavity during the later follow-up, the possibility of postoperative swelling of the external nose and aggravation of nasal congestion would have been significantly reduced if the patient was treated early.