Complex lesion in the nasal dorsum with necrosis of dermal tissues: case report

Abstract

Introduction: Injuries to the nasal region are the most frequent when compared to facial trauma in general. Common etiological factors are physical aggression, car accidents, falls from height and sports practices. Aim: To report a case of a complex injury to the dorsum of the nose caused by an accident at work. Case report: A 45-year-old male patient with leukoderma and no comorbidities was admitted to the Governador Paulo Guerra Restoration Hospital (HR) with trauma to the nasal region. There was an extensive blunt injury related to the disinsertion of the soft tissues and cartilage of the nose, with mobility and bone crepitus, as well as epistaxis. The proposed treatment was repositioning and reinsertion of the septal nasal cartilage, synthesis of the soft tissues with repositioning of the nasal muscles and closed reduction of the fracture. In addition, an anterior nasal packing was installed to control epistaxis and to support the repositioned nasal bones. After 3 days, the nasal packing was removed. The sutures were removed 15 days later and necrosis of the dermis was observed. Selective debridement was carried out and healing by second intention was chosen for this area in order to prevent scar fibrosis and consequent aesthetic damage. Final considerations: In the case of the nasal region, it is important to consider aesthetic and functional repair and infectious prevention in the therapeutic approach. Closed treatment of these fractures and correct repositioning of the soft tissue is essential, preventing sequelae.