Skip to main content

Advertisement

SpringerLink
Log in

Blunt nasal trauma in children: a frequent diagnostic challenge

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

The clinical challenge in blunt nasal trauma in children, is to identify cases requiring specialized care among frequently encountered banalities, whilst trying to minimize the exposure to diagnostic procedures. We aim to evaluate the related diagnostic and therapeutic pathways and its outcome during follow-up.

Methods

This retrospective cohort study includes children up to 16 years presenting at the emergency department with blunt nasal trauma of our tertiary reference center.

Results

The incidence of blunt nasal injuries was estimated 1750 cases in 7 years. A total of 459 consecutive cases with suspected complications were enrolled. Univariate comparison between age groups revealed a statistically significant diminution of downfall related injuries with growing up, whereas blows (including violence) significantly increased with age (p < 0.001 each). The logistic regression model identified male sex as an independent risk factor for soft tissue lesions (OR 1.699, p = 0.017) and for frontobasal fractures (OR 2.415, p = 0.050). Age was not identified to play a significant role regarding localization of injuries. Delayed septorhinoplasties became necessary in 2 cases only (0.4%). The logistic regression model identified nasal bone fracture (OR 17.038, p < 0.001) and mandibular fracture (OR 4.753, p = 0.004) as independent risk factor for a surgical intervention.

Conclusions

Blunt trauma to the nose is frequent in children. Trauma mechanisms differ significantly between age groups, whereas localization and concomitant injuries do not. Male sex was identified as an independent risk factor for soft tissue lesions and frontobasal fractures. In our experience, initial triage by the pediatric department with consecutive involvement of the ENT specialists in case of suspected complications is safe and effective and may help to reduce unnecessary diagnostic procedures/irradiation to the young patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Iizuka T, Thorén H, Annino DJ Jr, Hallikainen D, Lindqvist C (1995) Midfacial fractures in pediatric patients. Frequency, characteristics, and causes. Arch Otolaryngol Head Neck Surg 121(12):1366–1371

    Article  CAS  PubMed  Google Scholar 

  2. Simon B, Letourneau P, Vitorino E, McCall J (2001) Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma 51(2):231–237 (discussion 237–8)

    Article  Google Scholar 

  3. Dispenza F, Saraniti C, Sciandra D, Kulamarva G, Dispenza C (2009) Management of naso-septal deformity in childhood: long-term results. Auris Nasus Larynx 36(6):665–670

    Article  PubMed  Google Scholar 

  4. Alvarez H, Osorio J, De Diego JI, Prim MP, De La Torre C, Gavilan J (2000) Sequelae after nasal septum injuries in children. Auris Nasus Larynx 27(4):339–342

    Article  CAS  PubMed  Google Scholar 

  5. Gassner R, Tuli T, Hächl O, Moreira R, Ulmer H (2004) Craniomaxillofacial trauma in children: a review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg 62(4):399–407

    Article  PubMed  Google Scholar 

  6. Eggensperger Wymann NM, Hölzle A, Zachariou Z, Iizuka T (2008) Pediatric craniofacial trauma. J Oral Maxillofac Surg 66(1):58–64 (Review)

    Article  PubMed  Google Scholar 

  7. Belechri M, Petridou E, Kedikoglou S, Trichopoulos D, Sports Injuries European Union Group (2001) Sports injuries among children in six European union countries. Eur J Epidemiol 17(11):1005–1012

    Article  CAS  PubMed  Google Scholar 

  8. Hoppe IC, Kordahi AM, Paik AM, Lee ES, Granick MS (2014) Age and sex-related differences in 431 pediatric facial fractures at a level 1 trauma center. J Craniomaxillofac Surg 42(7):1408–1411

    Article  PubMed  Google Scholar 

  9. Vyas RM, Dickinson BP, Wasson KL, Roostaeian J, Bradley JP (2008) Pediatric facial fractures: current national incidence, distribution, and health care resource use. J Craniofac Surg 19(2):339–349 (discussion 350)

    Article  PubMed  Google Scholar 

  10. Soleimani T, Greathouse ST, Bell TM, Fernandez SI, O’Neil J, Flores RL, Tholpady SS (2015) Epidemiology and cause-specific outcomes of facial fracture in hospitalized children. J Craniomaxillofac Surg 43(10):1979–1985

    Article  PubMed  Google Scholar 

  11. Brussoni M, Olsen LL, Pike I, Sleet DA (2012) Risky play and children’s safety: balancing priorities for optimal child development. Int J Environ Res Public Health 9(9):3134–48

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bede SY, Ismael WK, Al-Assaf D (2016) Patterns of pediatric maxillofacial injuries. J Craniofac Surg 27(3):e271–e275

    Article  PubMed  Google Scholar 

  13. Allareddy V, Itty A, Maiorini E, Lee MK, Rampa S, Allareddy V, Nalliah RP (2014) Emergency department visits with facial fractures among children and adolescents: an analysis of profile and predictors of causes of injuries. J Oral Maxillofac Surg 72(9):1756–1765

    Article  PubMed  Google Scholar 

  14. Dispenza C, Saraniti C, Dispenza F, Caramanna C, Salzano FA (2004) Management of nasal septal abscess in childhood: our experience. Int J Pediatr Otorhinolaryngol 68(11):1417–1421

    Article  CAS  PubMed  Google Scholar 

  15. Tien DA, Krakovitz P, Anne S (2016) Nasal septal abscess in association with pediatric acute rhinosinusitis. Int J Pediatr Otorhinolaryngol 91:27–29

    Article  PubMed  Google Scholar 

  16. Cai Y, Saqi A, Haddad J Jr (2017) Spontaneous nasal septal abscess presenting as a soft tissue mass in a child. J Emerg Med 52(4):e129–e132

    Article  PubMed  Google Scholar 

  17. Dubach P, Aebi C, Caversaccio M (2008) Late-onset posttraumatic septal hematoma and abscess formation in a six-year-old Tamil girl-case report and literature review. Rhinology 46:342–343

    PubMed  Google Scholar 

  18. Ambrus PS, Eavey RD, Baker AS, Wilson WR, Kelly JH (1981) Management of nasal septal abscess. Laryngoscope 91(4):575–582

    Article  CAS  PubMed  Google Scholar 

  19. Liu C, Legocki AT, Mader NS, Scott AR (2015) Nasal fractures in children and adolescents: mechanisms of injury and efficacy of closed reduction. Int J Pediatr Otorhinolaryngol 79(12):2238–2242

    Article  PubMed  Google Scholar 

  20. Nishioka H, Kondoh S, Yuzuriha S (2018) Convex bone deformity after closed reduction of nasal bone fracture. J Plast Reconstr Aesthet Surg 71(1):85–89

    Article  PubMed  Google Scholar 

  21. Lim H, Kang KR, Koh SH, Jung SW, Jung S (2017) Postoperative changes after closed reduction of nasal fracture. J Craniofac Surg 28(7):1649–1653

    Article  PubMed  Google Scholar 

  22. Ridder GJ, Boedeker CC, Fradis M, Schipper J (2002) Technique and timing for closed reduction of isolated nasal fractures: a retrospective study. Ear Nose Throat J 81(1):49–54

    Article  Google Scholar 

  23. Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR 176(2):289–296

    Article  CAS  PubMed  Google Scholar 

  24. Chen JX, Kachniarz B, Gilani S, Shin JJ (2014) Risk of malignancy associated with head and neck CT in children: a systematic review. Otolaryngol Head Neck Surg 151(4):554–566

    Article  PubMed  PubMed Central  Google Scholar 

  25. Oikarinen H, Meriläinen S, Pääkkö E, Karttunen A, Nieminen MT, Tervonen O (2009) Unjustified CT examinations in young patients. Eur Radiol 19(5):1161–1165

    Article  PubMed  Google Scholar 

  26. Alcalá-Galiano A, Arribas-García IJ, Martín-Pérez MA, Romance A, Montalvo-Moreno JJ, Juncos JM (2008) Pediatric facial fractures: children are not just small adults. Radiographics 28(2):441–61

    Article  PubMed  Google Scholar 

  27. Gürkov R, Clevert D, Krause E (2008) Sonography versus plain X rays in diagnosis of nasal fractures. Am J Rhinol 22(6):613–616. [Erratum in: Am J Rhinol. 2009 Mar–Apr; 23(2):238]

    Article  PubMed  Google Scholar 

  28. Tamada I, Mori T, Inoue N, Shido H, Aoki M, Nakamura Y, Kamogawa R (2017) An algorithmic approach using ultrasonography in the diagnosis of pediatric nasal bone fracture. J Craniofac Surg 28(1):84–87

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Urs Borner and Lukas Anschuetz are equally contributing first authors.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Urs Borner, Lukas Anschuetz, Patrick Dubach & Marco Caversaccio

  2. Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Nadine Kaiser

  3. Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland

    Alexander Rieke

  4. Department of Otorhinolaryngology, Head and Neck Surgery, Burgerspital Solothurn, Solothurn, Switzerland

    Patrick Dubach

Authors
  1. Urs Borner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lukas Anschuetz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadine Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Rieke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Dubach
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Caversaccio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lukas Anschuetz.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Research involving human and/or animal participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional, regional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borner, U., Anschuetz, L., Kaiser, N. et al. Blunt nasal trauma in children: a frequent diagnostic challenge. Eur Arch Otorhinolaryngol 276, 85–91 (2019). https://doi.org/10.1007/s00405-018-5183-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5183-1

Keywords

Search

Navigation