Burns are caused by exposure of the nasal area to hot liquids, steam, and high doses of UV radiation (sunburns). As the temperature of the damaging liquid (vapor) and exposure time increase, the lesion volume increases accordingly.

Anatomy of nasal burns

Burns are categorized according to the depth of the injury.

In superficial burns (corresponding to the 1st degree), only the upper layer of the skin – the epidermis – is damaged.

In superficial incomplete layer burns (2nd degree), the epidermis and upper layers of the dermis (papillary layer) are damaged.

In deeper burns (3rd degree), the epidermis, subcutaneous fatty tissue and skin appendages (hair follicles, sweat glands) are affected.

In deep full-thickness burns (4th degree), in addition to the skin proper, necrosis of muscles, tendons and cartilage occurs, exposing bone tissue.

Healing of the first two degrees occurs by epithelization of the wound surface, 3-4 due to the growth of scar tissue.

Clinical manifestations nasal burns

Burns of any degree produce severe pain at the site of the lesion.

Grade 1 is characterized by hyperemia of the skin. The burn site is painful on palpation, when pressing – pale.

In 2nd degree burns, serous blisters with transparent contents are formed on hyperemic skin, the bottom is pink. Bubbles may form delayed within 24 hours of the burn. It is also characterized by soreness on palpation.

2nd degree nose burn — 2nd degree nasal burn – 3D model

Grade 3 injuries are characterized by the formation of serous hemorrhagic blisters on hyperemic and infiltrated skin. There may also be dry necrosis. The area of the lesion is moderately painful or painless, and hair falls out.

Deep full-thickness burns of the 4th degree are characterized by the formation of black scab. The wound is painless, the wound bed is represented by bone tissue. It should be noted that isolated nasal burns are extremely rare and are usually accompanied by damage to other areas.

Classification of nasal burns by depth of injury

Degree	Depth of lesion	Local changes	Soreness	Healing
1st degree	Epidermis only	Hyperemia (redness) of the skin. On palpation, there is soreness. When pressure is applied, the area turns pale.	Moderate, when touched	Epithelialization, without scarring
2nd degree	Epidermis + upper dermis layers (papillary layer)	Serous blisters with transparent contents on hyperemic skin. The bottom of the bubbles are pink. Bubbles may appear for up to 24 hours.	Expressed	Epithelialization, without scarring
3rd degree	Epidermis, dermis, subcutaneous fatty tissue, skin appendages	Serous hemorrhagic blisters, dry necrosis. The skin is hyperemic and infiltrated. The hair is easily removed.	Reduced or absent	Scarring
4th degree	All layers of skin, muscle, tendons, cartilage, possibly bone	Black scab, the bottom of the wound is represented by bone tissue. Extensive necrosis.	Absent	Gross scarring

Diagnosis nasal burns

Establishment of the diagnosis is based on collection of trauma history and otorhinolaryngologic examination. At the pre-hospital stage, it is mandatory to assess the patency of the respiratory tract. Subsequently, the nasopharyngeal mucosa is regularly reassessed for early detection of burns, reactive mucosal edema, and prevention of respiratory failure. It is necessary to assess the depth and volume of the lesion from the total body surface area to determine further treatment tactics. In case of a large area of damage to prevent the development of systemic complications perform biochemical study of blood, urine, ECG.

Treatment of nasal burns

It is imperative that the exposure to the damaging factor is stopped first. In case of smoke inhalation in the pre-hospital stage, insufflation of humidified oxygen is started.

If possible, it is necessary to cool the injured area of the body, adequately anesthetize the patient. For superficial burns, local therapy is recommended. Dressings with antibacterial ointments are prescribed . Small blisters should not be opened, while larger blisters should be dissected. Skin flap transplantation is indicated for patients with deep burns .

Extensive and deep burns require treatment in a burn hospital.

Nasal frostbite

Etiology of nasal frostbite

Frostbite is caused by prolonged exposure of exposed areas of the body to low temperatures. With prolonged stay in unfavorable environmental conditions in the form of high humidity, wind frostbite can occur even at plus temperature.

Anatomy of nasal frostbite

Exposure to cold causes direct freezing of cells and subsequently cell death. Also in frostbite there is a disturbance of blood circulation in the form of spasm of the distal parts of small blood vessels. Tissue ischemia occurs, which leads to cell death. The exact degree of frostbite in some cases can be assessed after several days, as characteristic changes appear delayed (blisters are formed after 4-8 hours, demarcation line at necrosis after several days).

In frostbite of the 1st degree, the superficial layers of the dermis are affected, there is pallor of the skin.

Grade 2 frostbite is characterized by the formation of serous blisters on pale skin.

Grade 3 frostbite has deep skin lesions. Blisters filled with hemorrhagic contents are formed.

The 4th degree of frostbite is characterized by necrosis of the entire thickness of the skin and underlying tissues. Dry gangrene is formed, distal areas are covered with black dry scab, in some cases self-amputation occurs. The skin is cyanotic, marbled. The lesions are combined with 2nd and 3rd degree manifestations, and the formation of blisters with various contents.

Clinical manifestations nasal frostbite

Frostbite is initially characterized by burning and numbness of the affected area. The frostbitten area is pale, cold, hard, marbled. After warming, there is severe pain, the greater the degree of lesion, the more pronounced the pain syndrome. The skin becomes brightly hyperemic, edematous. Each of the degrees is characterized by local skin changes, which have been described above.

Classification of nasal frostbite by depth of injury

Degree	Depth of lesion	Local changes	Soreness	Healing
1st degree	Superficial layers of the dermis	Skin pallor, numbness, burning, cold area. After warming – hyperemia, swelling. No bubbles are forming.	Moderate, worsens after warming up	Fast, no scarring
2nd degree	Epidermis + upper dermis layers (papillary layer)	Serous blisters with clear contents appear after 4-8 hours. Skin is pale, cold. Later, swelling, hyperemia.	Expressed	Complete, hyperpigmentation may occur
3rd degree	Deep layers of skin	Bubbles with hemorrhagic contents, the skin is marbled, cyanotic. The hair on the affected area falls out. Later, necrosis.	Strong, then decreased	Slow, with scarring
4th degree	All skin and underlying tissues (PJC, muscle, bone)	Cyanotic, marbled skin. Dry gangrene, black dry scab, self-amputation. It is often combined with signs of grade 2-3. Demarcation in a few days.	Absent due to nerve endings dying	Slow, with tissue loss and gross scarring

Diagnosis nasal frostbite

Diagnosis is based on the collection of history and complaints. The general condition and local changes are assessed.

Treatment of nasal frostbite

It is necessary to warm the injured area of the body. Under no circumstances should the skin be rubbed or open fires used, as there is a high risk of burns due to the lack of sensitivity. You can immerse the injured area in warm water or apply a dry warm bandage. Patients must be adequately anesthetized, and in some cases opioid analgesics are used. In general hypothermia of the body is recommended warm drinking, thermal blankets. Local treatment consists of treating the blisters with antibacterial ointments, applying sterile dressings. To improve tissue perfusion, anticoagulants, antiaggregants, vasodilators are prescribed. If dry gangrene is present, amputation is performed after a few days.

FAQ

1. Why is it not always possible to determine the degree of frostbite immediately?

Profound changes are not immediately apparent: blisters are formed after 4-8 hours, and the demarcation line after several days. The final evaluation of the degree is carried out in dynamics.

2. Why should I not rub my skin when I have frostbite?

Rubbing tissues that have lost sensitivity can cause mechanical damage and even thermal burns if an open heat source is used. Against the background of ischemia and cell death, this increases the risk of secondary complications and infections. Passive warming – using warm water or dry heat – is considered the correct way to warm up.

3 What is the difference between treating burns and frostbite?

In burns, it is important to eliminate the thermal factor, provide pain relief and prevent infection. Frostbite requires gradual warming, restoration of blood flow, and treatment of vascular disorders. Necrotized areas are sometimes surgically removed.

4. Is it possible to have a combined burn and frostbite injury at the same time?

In some clinical situations, especially when an inappropriate attempt is made to warm the frostbitten area with an open flame or hot objects, it is possible that thermal burns may be superimposed on tissue already damaged by the cold. This significantly worsens the course, increases the area of necrosis and increases the risk of complications.

5. What complications can develop in burns and frostbite of the nose?

Major complications include infection of the wound surface, gross scarring, and deformities of the external nose. Deep burns and frostbite can damage the cartilaginous skeleton, which can lead to persistent respiratory difficulties and impaired sense of smell. Also, when the nasal mucosa is affected, swelling often develops, complicating nasal breathing and creating a risk of secondary infection.

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