EXTERNAL NOSE, NASAL ORIFICES AND SEPTUM 23
anaesthesia allows the surgeon to elevate the depressed bone, which may be
impacted, and reposition it. Sometimes impaction is so great that the opposite
bone should be elevated laterally to disimpact the fractured one which may
then be manipulated into place. Splinting is not usually necessary, but some
surgeons prefer to fix the bones in place with splints of gauze in collodion or of
plaster of Paris. Fracture of the tips of the nasal bones may be elevated
together under pentothal anaesthesia using forceps inside the nasal cavities
Fig. 16. Fracture of the nasal bones -with
depression of the tip.
until the shape of the nose has been restored. In severe fractures with splinter-
ing of the bones repositioning of the fragments is required and the nose
should be splinted by a plaster-of-Paris headband.
Fractured nasal bones which have not been treated become fixed in about
2 weeks, after which it may be extremely difficult or impossible to refracture
them and reposition the bones. Such cases may call for plastic surgical
correction. Patients with such an uncorrected deformity may again injure the
nose and report the recent accident but make no mention of any previous
one. Radiography will show the previous fracture and it may only be at an
attempted manipulation when repositioning is impossible that the true state of
In motor car accidents, when the head strikes the dashboard, fracture of the
nasal bones may be associated with fractures of the zygoma and maxilla, and
in these cases extensive procedures are required to correct the deformities.
SEPTAL HAEMATOMA AND ABSCESS
Haematoma of the nasal septum may result from injury or may follow septal
surgery. Extravasation of blood causes a smooth rounded swelling affecting
both sides of the nasal septum and causing pain and bilateral nasal obstruction.
The swelling is easily visible inside each nostril (Plate 1,1). Infection frequently
supervenes to transform the condition into a septal abscess with increase of
pain. Under general anaesthesia a wide-bore needle is inserted into the
swelling and the contents are aspirated into a syringe. If no pus is found*
aspiration may continue until no more blood is obtained, and the two nasal