Childhood Nose Trauma and Its Impact in Later Years
The health effects of nasal trauma in childhood can sometimes occur in the long term. The most important growth points in nasal development are on the nasal septum which divides the nasal cavity in two. Since bruise traumas in children mean the crushing of growing bone and cartilaginous tissues, the effects of trauma on the nose can become evident over the years as nasal development continues.
Serious trauma injuries rarely occur in the pediatric population, but nasal injuries are more common. Assessment and treatment of nasal trauma are quite different to children in comparison to adult nasal rashes. Poor patient cooperation during physical examination, combined with significant anatomic differences, may lead to a more difficult diagnostic dilemma for the KBB specialist. Surgical treatment of pediatric nasoceptor injuries on nasal and midfacial growth that disturbingly progresses to nasal growth centers is controversial (source: Pediatric nasal injuries and management).
Unlike adults, childhood nasal trauma has the following characteristics:
➤ As seen in the photo on the side, bruise fractures in children are generally age-tree shrubs and can be planned for follow-up without intervention unless they have severe curvature and breathing problems
➤ Asymmetric bruising can occur at the nose septum, crushing and nose growth, before fracture occurs in the nasal bone in children. In children with a previous nose trauma story and a flat nose, there are different situations such as turning right or left on the nose as the age progresses, dislocating the lower part of the septum (caudal septum part) from the nose tip, asymmetric nasal asymmetry and nasal asymmetry It can rise up. Links to find more information on curved nasal deformities >>Deviated Nose and Treatment Challenges (Turkish Video) / Nasal Septum Deviation Animation
➤ Especially in children who fall on the nose or have an impact from the front to the back of the nose, there can be very different symptoms, such as caudal septum deviation, laxity at the tip of the nose, and sagging nose, nasal obstruction, nasal swelling due to cartilage damage and damage to the nose growth point . Because the nasal bone is not broken, there is swelling and bruise in the nose; the nose growth points may be damaged and the change in nose shape with growth may become evident.
➤ A lateral x-ray can be requested less frequently than in adults because of nose trauma, nasal trauma, thyroid tissue in the neck region, and developing tissues. Plain radiographs do not help in the diagnosis of nasal cracks in children and should not be done for this purpose alone. "X-rays should never be used to replace the full intranasal examination of any child with nasal trauma Any nasal abnormality should be indicated for immediate evaluation and treatment" source >> Nasal septal trauma in children
➤ The symptoms and findings of of the nasal trauma in children is not different from that of adults and can be listed as follows:
• Nose bleeding
• Swelling (it is not a definite sign of burn rupture alone, it can also occur in soft tissue trauma!)
• Nasal obstruction
• Bruises under the eyes (this is perhaps the most serious and easiest to understand bone fracture)
• Sensitivity when touched
• When the bone is touched, the creeping voice (creep)
• Difficulty in breathing through the nose (nasal obstruction after bruise trauma)
• Nose deformity
➤ When children have nasal bone fractures, attention should be paid to sportive activity: time is needed for nose healing. The nose can be easily evacuated during this time. For this reason, most clinicians recommend that children stay away from all sports for at least 2 weeks. Your child should avoid contact sports (such as football, wrestling) for at least 6 weeks.
➤ Nasal fractures are more common in adults than in children. In children, the nasal bones are more difficult to break. Breaking the nose is very rare in young children. Risk increases with age. Nose fractures are seen in boys rather than girls. The nose bone is one of the facial bones and actually plays a major role in the absorption of the pulse. The lower part of the nasal bone is more incarcerated than the upper part and can break easily (source: Nasal Fracture in Children).
➤ Young children with nasal fractures should also be aware of additional trauma finding (source: Nasal trauma and fractures in children):
• All children with facial trauma should be assessed for cervical spine, central nervous system, chest, orbital and spinal injuries
• Children with visual acuity, diplopia, and sensory deficits must make immediate assessment of neurological or ophthalmological trauma
• Children with malocclusion should be evaluated for mandibular fractures and tooth injuries
• Frontal sinus sensibility may indicate frontal sinus fractures
• Palpation sensitivity of nose tip suggests septal hematoma
• Malocclusion and instability in the palate are indicative of midfacial LeFort fracture
• Anterior palpebral palpation of the nasal spine may result in significant septal trauma
➤ After nasal trauma in children, the nose septum may become blood-filled and septal hematomas may develop. Septal hematoma indications in children can be listed as follows (infants with septal hematomas include: Infected nasal septic hematoma / abscess after nasal trauma)
• Septum blue or red color change and asymmetry
• Swelling in the nasal mucosa that prevents nasal passage
• The size of the mass does not change with topical vasoconstrictive agents (ie, the complaint of nasal congestion and nasal congestion does not occur)
➤ Childhood nasal fractures can be complicated by structural or cosmetic deformity. In addition to cosmetic complications, nasal bone fractures may be complicated with the following (very rare) (sources: Evaluation of lacrimal drainage system obstruction using combined ... / Maxillary hypoplasia secondary to midfacial trauma in childhood / Toxic shock syndrome after closed reduction of a nasal fracture / An unusual presentation of a nasal septal abscess):
Septal abscess (described above) can cause intracranial infection, which is caused by direct diffusion into the cavernous sinus
• Lacrimal channel obstruction
• Maxillary hypoplasia
• Toxic shock syndrome
• Naso-oral fistula
➤ All patients with nasal bone fractures and / or septal hematomas that cause airway obstruction should be assessed quickly by an otolaryngologist (source: Nasal and Septal Fractures: Background, Epidemiology, Etiology).
Childhood is a time of exploration, learning, and, unfortunately, occasional accidents. While children are known for their resilience, it's crucial to recognize that the repercussions of childhood incidents may not always manifest immediately. One such concern that often goes unnoticed is childhood nasal trauma, which can have lasting effects that become apparent in later years. In this article, we'll delve into the potential long-term consequences of childhood nasal trauma and why it's essential to address these issues proactively.
Understanding Childhood Nasal Trauma
Childhood nasal trauma can result from various incidents, including falls, sports injuries, or accidents during play. The nose, being a prominent facial feature, is susceptible to injury, and even seemingly minor incidents can have lasting effects. Common consequences of childhood nasal trauma include nasal fractures, deviated septum, and damage to the delicate nasal structures.
Immediate vs. Delayed Effects
While some children may experience immediate symptoms such as bleeding, swelling, or pain following nasal trauma, others may not display noticeable issues at all. It's the latter group that may be at risk for delayed consequences, with problems surfacing in adolescence or adulthood. These delayed effects can include breathing difficulties, chronic sinus issues, and cosmetic concerns like nasal deformities.
Childhood nasal trauma can lead to a deviated septum or other structural abnormalities that compromise nasal airflow. As the child grows, these issues may become more pronounced, resulting in chronic nasal congestion, snoring, and even sleep apnea. Identifying and addressing these breathing difficulties early on can significantly improve the individual's quality of life.
Chronic Sinus Issues
Damage to the nasal structures during childhood can contribute to chronic sinus problems in later years. Recurrent sinus infections, headaches, and facial pain may become persistent issues that impact daily life. Timely intervention, including medical treatments and surgical options if necessary, can help manage these conditions effectively.
Nasal trauma during childhood can also lead to aesthetic concerns that become more noticeable as the individual matures. Deviations in the nasal structure, asymmetry, or visible deformities may affect self-esteem and confidence. Thankfully, advancements in cosmetic and reconstructive procedures offer solutions to address these concerns and restore a natural appearance.
It's crucial for parents, caregivers, and healthcare providers to be vigilant about childhood nasal trauma and its potential long-term consequences. Even if immediate symptoms are absent, the impact can manifest later in life, affecting breathing, sinus health, and overall well-being. Seeking timely medical attention, monitoring for any signs of delayed effects, and exploring appropriate interventions are key to ensuring a healthy and comfortable future for individuals who may have experienced childhood nasal trauma.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47