Thermal Lesions of the External Nose: Burns and Frostbite

Thermal lesions of the nose – exposure to extremely low or high temperatures with damage to the skin and underlying tissues.

Nose burns

Etiology of nasal burns

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.

Anatomyof 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 manifestationsnasal 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.

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

Diagnosisnasal 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

Etiologyof 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.

Anatomyof nasal frostbite

Exposure to cold causes direct freezing of cells and subsequently celldeath. 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 manifestationsnasal 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

Diagnosisnasal frostbite

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

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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.