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Nasal injuries are very common in children. They may occur in isolation or may be associated with other facial fractures, like the bone around the eye, and fractures of the upper and lower jaw. The leading causes of injury include unintentional falls, sports-related injuries and motor vehicular accidents (MVA).
Accidental falls account for the majority of nasal injuries in children aged 5-12 years, while sports-related injury account for the majority of the nasal bone fractures in adolescents. In very young children, their nose is mainly soft tissue which creates cushion in case of trauma. As a result, they are less prone to nasal fractures.
Where exactly are nasal bone fractures?
There are two nasal bones (right and left) that form the uppermost part of the bridge of the nose. When the skin overlying the nasal bones is intact, the fracture is called a closed fracture, whereas if the nasal bones are exposed, the fracture is called an open fracture. Open nasal bone fracture is usually associated with significant facial injury such as that seen in MVAs.
How do you know if your child has a fracture?
The important thing to remember is a nasal injury is rarely associated with other severe life-threatening injuries. So, if your child has other symptoms, such as loss of consciousness, vomiting, breathing difficulty, or blurry vision, call 911 or take your child to the nearest Emergency Center (EC). Fortunately, many nasal injuries in children are isolated and not associated with other facial fractures. Typically, symptoms of an isolated nasal bone fracture include significant soft tissue swelling around the nose with bruising and swelling under the eyes. There may also be significant bleeding from the nose which usually prompts an EC visit. In severe cases, the nose may look obviously deviated with pain and tenderness over the nose.
When does your child need to see an Ear, Nose and Throat (ENT) Doctor?
Children with nasal injuries are usually seen in the EC first and then follow up with an ENT physician. Your child will not need to see an ENT physician on the day of the injury, rather, your physician will recommend a visit to an ENT specialist within five to seven days of the injury, after the soft tissue swelling around the nose subsides. This allows the ENT physician to evaluate the nasal area more accurately for evidence of underlying fracture.
Diagnosis of nasal bone fracture
Nasal bone fracture is diagnosed clinically. It is important to allow the swelling around the nose (usually between three and five days after the injury) to decrease before evaluating for fractures. Your EC or ENT physician will perform a thorough external and internal nasal exam. They may also perform an X-ray of the nasal bones if needed.
Treatment of nasal bone fracture in children depends on the severity of the injury and whether your child is experiencing functional problems, such as difficulty breathing through the nose. The nasal cartilage has growth centers for the development of the mid-face, therefore surgery is rarely a treatment option.
One of the reasons to perform surgery is to drain a septal hematoma; usually seen in very young children after facial trauma. Septal hematoma means there is a collection of blood between the nasal cartilage and its covering. If the hematoma is not drained on time, it can lead to septal perforation and deformity of the nose.
Isolated nasal bone fracture is very common in children. The diagnosis is clinical and is based on the outer and inner appearance of the nose after an injury. Treatment is conservative, however, some children may require surgery to prevent future functional and structural problems.