Chevallet fracture: Difference between revisions
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Vascular markings look just like fractures and patients may be taken to theatre on the basis of a radiologist's report which relates to a vascular marking. |
Vascular markings look just like fractures and patients may be taken to theatre on the basis of a radiologist's report which relates to a vascular marking. |
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The importance of X-rays is to rule out more extensive fractures than are assessed clinically and also to make sure that the neck is not damaged. |
The importance of X-rays is to rule out more extensive fractures than are assessed clinically and also to make sure that the neck is not damaged. |
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Radiographs may also show that there is blood in the maxillary antrum. |
Radiographs may also show that there is blood in the [[maxillary antrum]]. |
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If a class 3 fracture is suspected, then computed tomography is essential to assess the damage to the ethmoid labyrinth and anterior cranial fossa. If the patient has a number of other facial injuries, then it is best to record these by photography. |
If a class 3 fracture is suspected, then computed tomography is essential to assess the damage to the [[ethmoid labyrinth]] and [[anterior cranial fossa]]. If the patient has a number of other facial injuries, then it is best to record these by photography. |
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[[File:Radiograph.jpg|thumbnail|right|x ray lateral view of skull and neck]] |
[[File:Radiograph.jpg|thumbnail|right|x ray lateral view of skull and neck]] |
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Revision as of 09:13, 20 October 2015
Chevallet fracture is a vertical fracture of nose which occurs when direction of blow on the nose is from below upwards.The vertical fracture that occurs in the nasal septum was first described by Chevallet and still bears his name.[1][2] Nasal trauma is extremely common form of fractures of face because of its central position and outward projection on the face[3]
Causes
Chevallet fracture can occur due to :
- -Personal assault
- -sports injuries
- -personal accidents
- -road traffic accidents.
The commonest cause is probably assault. In this group the people most affected are young males.[4]
Complications
- -Deviation of nose
- -Bleeding of nose
- -Saddling
- -Cerebrospinal fluid leak
- -Orbital complications
- -Healing
Pathogenesis
If the central part of the face is traumatized then five things can happen depending on the velocity and the direction of the blow. Five things may occur :
- -no fracture
- -class I fracture
- -class II fracture
- -class III fracture
- -Le Fort type II and III fractures
If the blow is of greater severity, then a class I fracture will result. The nasal bone,although one rather short bone, is in two distinct parts. The distal half is thin and easily broken from the proximal part which is joined to the frontal bone and becomes very thick. In class 1 fracture there is either breaks the quadrilateral cartilage or depression or displacement of the thin distal part of one of the nasal bones. Frontal blow can cause this type of fracture.[5]
Signs and Symptoms
The patient may come with the history of trauma in past. The trauma may also occur due to forceps delivery on the nasal skeleton and the immediate septal abnormalities due to fracture and distortion found after such deliveries. The patient who had severe trauma may have following complains. : Epistaxis, CSF leak, Diplopia, tearing or telecanthus, asymmetrical face.[6] The doctor must ask the patient about neck pain, limitation of neck movement and roof symptoms down the arm. Since every facial injury should be regarded as a potential neck injury.[7]
Examination
In first visit, immediate first aid is given to the patient & ask patient to visit again to the clinic after 5–7 days. It is essential to notice any discharge from nose like cerebrospinal fluid to get bleeding under control(nasal packing) . nasal drops are given to the patient, an incision should be performed under local anaesthesia in case of septal haematoma and drainage if necessary.
Nasal endoscopy
If there is sufficient airway then nasal endoscopy should be carried out.
Radiology
Usually there is no need for routine radiology in simple nasal injuries. Vascular markings look just like fractures and patients may be taken to theatre on the basis of a radiologist's report which relates to a vascular marking. The importance of X-rays is to rule out more extensive fractures than are assessed clinically and also to make sure that the neck is not damaged. Radiographs may also show that there is blood in the maxillary antrum. If a class 3 fracture is suspected, then computed tomography is essential to assess the damage to the ethmoid labyrinth and anterior cranial fossa. If the patient has a number of other facial injuries, then it is best to record these by photography.
Treatment
No treatment is generally required. Corrective septorhinoplasty is required. Packing may well be sufficient in these patients. Elevation of the nasal bone with accurate packing in the vault of the nose should be successful. Packing on the side that was obstructed by the fracture should be left in for at least 3 days.[8]
References
- ^ foster, craiy. surgery of facial bone fracture. churchill livinstone.
- ^ scott-brown, scott brown's otorhinolaryngology. head and neck surgery volume 2 (2 ed.).
- ^ ibraheem al-obiedi, salem hussain. "open and close reduction of fracture nasal bone". tikrit medical journal: 58–62.
- ^ scott-brown, scott brown's otorhinolaryngology. head and neck surgery volume 2 (2 ed.).
- ^ scott-brown, scott brown's otorhinolaryngology. head and neck surgery volume 2 (2 ed.).
- ^ scott-brown, scott brown's otorhinolaryngology. head and neck surgery volume 2 (2 ed.).
- ^ Scott's Brown otolaryngology, AGD Muran. the fracture nose (5 ed.). pp. 212–221.
- ^ scott-brown, scott brown's otorhinolaryngology. head and neck surgery volume 2 (2 ed.).
1.Open And Close Reduction In Treatment Of Fracture Nasal Bones.Salem Hussian Ibraheem Al-Obiedi Department of Surgery, College of Medicine, University of Tikrit,Tikrit Medical Journal 2005 ; 11(2)[1]open and close reduction in treatment of nasal fracture nasal fracture surgery 2.A.G.D Maran, The fracture nose,Scott-Brown's otolaryngology. Ian smackay; Rhino logy, Butter worth international edition, Fifth edition. 1987; 212-221.[2]scott-brown's otorhinolaryngology
3.Crait A. Foster et al. Surgery of facial bone fracture. Churchill Living stone.1987; 25-38.[3]Surgery of facial bone fracture 4.Scott-brown’s otorhinolaryngology, head and neck surgery, volume 2 [4]head and neck surgery 5. Dhingra diseases of ear,nose and throat[5]nasal septum and its diseases
- ^ al-obiedi, salem hussain ibraheem. "nasal fracture surgery". tikrit medical journal.
- ^ Scott's Brown otolaryngology, AGD Muran. the fracture nose (5 ed.). pp. 212–221.
- ^ foster, crait. surgery of facial bone fracture. churchill livinstone.
- ^ scott-brown, scott brown's otorhinolaryngology. head and neck surgery volume 2 (7 ed.). ISBN 9780340808931.
- ^ diseases of ear ,nose and throat, PL Dhingra shruti dhingra. nasal septum and its diseases (6 ed.). elsevier. p. 147. ISBN 9788131234310.
