Soft Tissue Injuries of the External Nose: Etiology, Clinical Presentation, Diagnosis and Treatment

The following types of injuries are differentiated:

• Nasal abrasions are superficial skin injuries that affect the papillary and reticular layers of the dermis.
• Nasal lacerations affect all layers of the dermis and can extend to soft tissue and muscle.
• A nasal avulsion is a cut or tear of the distal part of the nose caused by trauma.
• A nasal contusion is a bruise to the soft tissues of the nose that occurs due to blunt trauma but does not damage the skin.

Etiology

The cause of these conditions is a large mechanical impact on the nose area, such as falls, bites, sports injuries, traffic accidents, or work-related injuries. During warfare, stab wounds and blast injuries are the cause of nasal avulsions.

The nose is more likely to suffer traumatic injuries than other organs because it is the most protruding part of the body.

Anatomy

Nasal abrasions

Skin abrasions are characterized by partial damage to the epidermis that does not penetrate into the deep layers of the skin. After injury, they bleed and are then covered by a hemorrhagic crust.

Lacerations of the nose

A laceration wound is characterized by deeper damage, affecting all layers of the dermis and the underlying fatty tissue, vessels, muscles. The edges of the wound diverge, it gapes, there is profuse bleeding. More often injured alae and tip of the nose.

Nasal avulsions

• When the nasal tip is amputated, the distal part of the nose, including the skin, muscle, and cartilage, is severed, exposing the nasal cavity.
• During an avulsion of the nose, there is traumatic avulsion of the bone and cartilage base of the external nose. This exposes the pear-shaped aperture, and the nasopharynx is visible. In both cases, massive bleeding occurs.

Nasal contusions

In contusions, there is a pronounced edema of soft tissue both outside and in the nasal cavity. Soft tissue hematoma develops, less often a hematoma of the nasal septum may form.

The integrity of the skin and bone tissue is not disturbed. With a pronounced force of impact may tear the mucous membrane of the nasal cavity, nasal bleeding occurs.

Clinical presentation

Abrasions are characterized by soreness at the time of injury and scant bleeding. A hemorrhagic crust then forms, under which healing occurs.

When cuts and lacerations occur, pain tends to be felt both at the time of injury and until the wound is sutured. Profuse bleeding is characteristic. Nasal breathing may be impaired due to the development of reactive edema of the nasal cavity.

In nasal contusions, there is soreness at the time of injury. Slight pain can still be felt later, especially when palpating the nose. Nasal bleeding may occur immediately after the injury. A few hours after the injury, there is noticeable soft-tissue edema and hematoma of the perinasal region, including the paraorbital region. Nasal breathing is difficult due to edema of the mucosa of the nasal cavity.

Diagnosis of soft tissue injuries of the nose

Diagnosis is based on the medical history of injuries and an otorhinolaryngologic examination.

To exclude bone fractures, radiography of the nasal bones in lateral projections and the sinuses is performed.

To rule out deeper injuries, a facial CT scan is recommended.

Treatment of soft-tissue injuries of the nose

Primary surgical treatment of the wounds is performed. If necessary, the edges of the wound are excised as gently as possible. Cosmetic sutures are applied.

If the amputated nasal area is preserved and viable, reattachment is performed. If reattachment is not possible, plasty with a vascularized graft is performed later.

In the first hours after nasal contusions, cold compresses on the area of injury are recommended, and systemic NSAIDs, intranasal vasoconstrictors, and saline irrigation are prescribed.

If nasal bleeding continues, it must be stopped, including, if necessary, with an anterior nasal tamponade.

Antitetanus prophylaxis is required, and in case of animal bites, rabies post-exposure prophylaxis is, as well.