NOSE TRAUMA IN CHILDREN, WHAT TO DO?

Trauma or impact on the child's nose often occurs considering the child's activity tends to be excessive and inadvertent. Impact, especially in the nose, can cause cracks or fractures in the skeleton or nasal cartilage. Nasal fractures in children are a serious concern because the bone growth process is ongoing. Improper handling and in improper handling time can cause various problems in the form of changes in the structure of the nose and soft tissue around the nose and nasal cavity. This condition in the long term results in complications in the form of obstruction of the airway or changes in the nose or cosmetic appearance.

The occurrence of fractures in the nasal bones is due to the prominent position of the nasal bones and cartilage and is the central part of the face, so it is not strong enough to face external pressure. The weakest area of the nose is the cartilage skeleton and the junction between the cartilage and the bones in the cheekbones which in medical language is known as the maxillary crest. Based on the direction of impact, nasal fractures are divided into two, namely frontal or frontal injuries if the impact originates from the front, and lateral injuries if the impact originates from the side.

Nosebleeds that occur after a child has fallen are one of the most common symptoms and often cause concern for parents. Nosebleeds occur due to tearing of the mucous membrane of the nose or rupture of blood vessels in the nasal cavity. Nosebleeds can be treated by squeezing the nostrils for 15 minutes with the head slightly lowered. If there is a large number of nosebleeds and the child seems to have difficulty breathing, immediately go to the nearest emergency facility.

The doctor will then ask about the mechanism of impact on the child's nose (type, direction, magnitude of impact, time of occurrence), complaints that arise (for example: nasal congestion, bruising on the face or nose, nasal discharge). A history of nasal impact or previous nose jobs should also be traced by interviews with the parent or caregiver who saw the position of the child's fall.

After the nosebleed has been successfully treated, the next examination is carried out in the form of touching the outside of the nose using the fingers of the right and left hands (bimanual palpation) to look for areas that have cracks / fractures and crepitus due to broken bones / cartilage. The structure of the inner nasal cavity and nasal septum was evaluated using a nasal speculum instrument. Imaging examination in the form of a CT scan may be performed if a complicated nasal fracture / cartilage is suspected or multiple fractures of the headbone.

The principle of dealing with fractures / cartilage in the child's nose is to overcome emergency conditions by maintaining good airway, breathing and blood circulation. Nosebleeds that don't stop by squeezing the nostrils can be treated by inserting a nasal tampon. A blood clot (hematoma) on the side of the septum / bone that divides the nasal cavity can be surgically removed to remove the blood clot. The choice of operative action is performed on the fracture / cartilage of the nose with dislocation. The choice of surgical therapy or not preventable if parents can keep the child from experiencing trauma to the face and nose, so that the impact of long-term complications on the quality of breathing and cosmetics in adulthood can be prevented.