© Borgis - New Medicine 3/1999, s. 6-7
Mieczysław Chmielik1, Hubert Wanyura2, Iwona Jakubczyk1
Management of nasal trauma in children
1 Department of Paediatric Otorhinolaryngology, Warsaw Medical School, Poland
Head: Prof. Mieczysław Chmielik M.D.
Management of different nasal traumas, nasal fractures, and maxillary fractures in children are discussed. The principles of treatment are based on experience of the paediatric otorhinolaryngology and maxillo-facial surgery departments. The results of proposed treatments are discussed.
The child, who is inquiring and active, often encounters traumas, especially to the nose, because of its projection from the face.
The increased number of accidents related to the development of civilisation results in a growth of incidence of different nasal traumas in children. The number of traditional causes of deformations, such as a kick or a bite, has not decreased.
Time for diagnostic and therapeutic procedures in nasal trauma is limited because of the healing dynamics in children, so the principles of management should be clearly defined. On the other hand, the potential of facial development in a child gives a possibility of better healing of the injuries than in adults.
A trauma to the nose may cause injuries of the:
1. soft tissues,
2. septal and lateral nasal cartilages,
3. nasal bones:
- fracture without displacement,
- fracture with displacement,
4. central midface region.
A nasal injury resulting in soft tissue swelling does not usually require medical treatment except for debridement if an open wound is detected. However, in some cases haematoma along the septum may occur. An abscess of the septum which may develop from the haematoma usually results in the destruction of septal cartilage and severe nasal deformation such as „Saddle nose”. Hence, the septal haematoma should be drained and systemic antibiotics should be administered. If an abscess is detected this management should be also accompanied by inspection of the septal cartilage. If there is a loss of cartilage in regions I or III, simultaneous reconstruction is recommended with preserved cartilage used as a graft.
When the trauma results in nasal fracture with displacement, closed reduction is required in a maximum of 7 days time following the trauma. Delayed closed reduction may cause healing with misalignment. However, swelling occurring after trauma makes the assessment of deformity more difficult.
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