62.4 Fractures of the nose

A patient’s injured nose is displaced, swollen and bleeding. Sometimes the swelling hides his displaced bones underneath, so always suspect a fracture after any blow on the nose. He may have blood in his orbits and under the medial halves of both his conjunctivae.

A force applied to the side of the nose pushes it sideways. A force applied from in front squashes it and splays it outwards. If you don’t treat these injuries, they produce the deformities shown in Fig. 62-9. If the force is severe enough, it can: (1) Fracture the frontal processes of a patient’s maxillae. (2) Displace his nasal cartilages. (3) Dislodge his septal cartilage from its groove in his vomer. (4) Comminute his vomer. (5) Fracture his ethmoid bones so that CSF flows from his nose.

Figure 62.8: UNREDUCED FRACTURES OF THE NOSE. If you don’t reduce a patient’s broken nose, these are some of the possible results. After Killey, permission requested.