Fractures of the nasal bones account for about 10% of all fractures of the facial skeleton, can be accompanied by fractures of the orbit, sinuses, trellis labyrinth. Almost 40% of patients have a combined traumatic brain injury.
The clinical picture. Nose deformation (curvature, flattening, lateral displacement), soft tissue edema, nosebleeds, difficulty in nasal breathing. On palpation, mobility of bone fragments is noted. Treatment. Reposition of fragments under local infiltration anesthesia. Special elevators or hemostatic clamp with a rubber tube put on it. The instrument is carefully inserted into the nasal passage, the sunken fragments are lifted and adjusted with the pressure of a finger. Before reduction, blood clots should be removed from the nasal passages, and after reposition, the PVC tubes moistened with paraffin oil should be introduced along the lower nasal passage. The latter provide nasal breathing and relieve the patient from the formation of synechia .
Zygomatic bone and zygomatic arch fractures
Fractures of the zygomatic bone and zygomatic arch constitute about 10% of all fractures of the bones of the face. Injury of the zygomatic bones can occur as a result of a direct blow or when squeezing the facial skeleton. Displacement of fragments depends on the direction of the traumatic force and, rarely, on muscle contraction. Fractures of the zygomatic bone in almost half of patients are accompanied by combined injuries of the upper jaw (maxillary sinus), bones of the orbit and dew. 25% of patients have craniocerebral injuries (concussion and bruises of the brain, fractures or fissures of the base of the skull).
The clinical picture. Rapidly occurring swelling of soft tissues in the infraorbital and parotid-chewing areas, extending to the lower and upper eyelids; retraction of the zygomatic region after a decrease in swelling of the soft tissues (due to retraction of the zygomatic bone, down, posteriorly and medially , lower orbital margin with the formation of a “step”); bleeding from the nose and ears; pains and limitations when opening the mouth and when chewing; dizziness; noise in ears; hearing loss and visual acuity (diplopia); retinal hemorrhage, enophthalmos; displacement of the eyeball down; subcutaneous emphysema of the face on the side of the lesion; a change in sensitivity in the innervation of the lower orbital nerve. X-ray fracture of the zygomatic arch is easily recognized. For identification, an axial projection of the skull should be performed, as well as orthopantomography . Treatment. It depends on the degree of displacement of the fragments, the nature of the fracture and the timing of assistance after an injury. Fractures without displacement are treated conservatively. Reposition of fragments is carried out under local anesthesia. With a slight displacement, fragments can be set with a finger from the side of the vestibule of the oral cavity, Buyalsky’s shoulder blade or spatula. With a large displacement, surgical methods should be resorted to (external reduction with Limberg single-tooth hook or special forceps; Dubov’s intraoral method for the transitional fold in anticipation of the oral cavity; bone suture; suspension and extension of the zygomatic bone). In case of damage to the maxillary sinus, it is necessary to revise it. After reduction, the patient should limit the opening of the mouth, take liquid food until the 12-14th day after the injury.