Leading with your face

Friday, May 18, 2007

Steve Nash may have won two MVP awards but the image that may be remembered most graphically is his nose splayed open and bleeding on the hardwood floor. Just another consequence of leading with your face.

Actually nose injuries are pretty common in the ER and people come in always asking the same question. “Is my nose broken?” And the answer invariably is yes. The next response usually takes the patient aback and needs some explanation, so here we go.

When you get hit in the face, it is often the nose that takes the brunt of the injury. It is the first point of contact for falls, or when objects accidentally get pushed into the face and it is the prime target when somebody takes a swing. If you get hit in the nose and it is associated with a nosebleed, that bleeding is most likely due to a break. It may be the cartilage or the bony part of the nose, but trauma and bleed equals break. And so we don’t get tied up with semantics, broken, fractured and cracked all mean the same thing.

After your trauma, should you present to your doctor, there are a few things that will happen. The first is to make sure there are no other associated injuries, like a broken bone in the midface, those bones that support the eyes (inferior orbital rims) and the upper teeth (maxilla). Then, using a nasal speculum, the name of the instrument used to spread the nose apart, he will check to make sure there isn’t a hematoma or clot on the cartilage of the nose. This is one of the few things that actually has to be dealt with urgently after nose trauma. Otherwise, it’s just time and don’t expect any Xrays, because they don’t matter. Broken or not the treatment is initially the same. Time and ice.

Because the face has such good blood supply, a broken nose will swell quickly and it may be hard to tell if there is a cosmetic deformity. So after 3 or 4 days of ice, the patient is referred to an ears nose and throat doctor to decide if the broken bones need to be reduced, that is to have the nose straightened. Since it takes the bones a couple weeks to heal, there is no huge rush to see and ENT specialist. But when you get there and should it be recommended that bones need to be fixed, it can happen in the office under local anesthetic.

Steve Nash, an ex-pat Canadian, should at least be aware of the concept of broken noses. In hockey, a broken nose is a reminder to keep your head up when you have the puck, otherwise a stiff check will bring nose and stick together. Nash also seems to understand that a little tape, glue and stiff upper lip gets you back into the game quickly.

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