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Rasulova Mukhsina Razikovna, assistant of the Chair of Forensic Medicine and Pathological Anatomy Samarkand State Medical Institute E-mail: [email protected]
FORENSIC EXAMINATION OF FRACTURES OF THE BONES OF THE NOSE
Abstract: The presence of age, sex and regional features, the variety of fractures of the bones of the nose and its septum are shown. As a result, in the forensic medical examination of the FNB, the nature and extent of lesions, features of the anatomical structure of the nose bones, possible anomalies in their development, concomitant diseases, possible complications and consequences of trauma are taken into account.
Keywords: fractures of the nose bones (FNB), orbit, septa.
There is a big difference in the indices of the causes of nasal trauma, including fractures of the nose bones (FNB), in the studies of different authors. Similar data are also noted for sex and age indicators [1; 2; 3]. In this regard, the solution of problems associated with fractures of the nose should be carried out constantly taking into account the regions, possible new situations, seasonality.
The prevalence and diversity of FNB has led to a large number of studies of this type of trauma, which have not dried up to date. However, a number of problems concerning forensic medical examination still remain insufficiently studied. They concern the insufficient degree of study of morphological features of injuries, methodological approaches to forensic diagnostics and expert evaluation of post-traumatic disorders [4].
To understand the mechanism and extent of injury, researchers again and again turn to the anatomical structure of the nose. The nose is formed by the front and back bones, as well as the front and rear cartilages. The twin nasal bones, the frontal bone and the processes of the upper jaw form the support for the cartilaginous skeleton. Although most of the structures of the nose are cartilaginous, if damaged, a fracture of his bones occurs. Since the supporting nasal septum has the shape of a natural cone, it becomes more and more thin near the tip of the nose and is more prone to fracture in this place [5].
It should be noted that the nasal cavity of brachycephalic, mesocaculum and dolichocephalic differ in the height and width of the nasal passages in different sections [6]. There are also racial features of the facial structure. Taking into account nationality and ethnic characteristics, four types of external nose are distinguished: 1) the eastern type, characteristic of the peoples of Asia; 2) the Caucasian type is leptoric; 3) Negroid type - platinum; 4) European type, in which three basic forms are distinguished: straight, convex-vaulted (high and narrow back of nose), concave-deepened (broad and low back of nose) [7]. Apparently, the nose of small size is less susceptible to fracture than large.
Since the bones of the wasp are flat and thin, their fractures are often multi-lobed. Together with the nasal bones, fractures of the frontal processes of the maxilla can occur.
Nasal bones are damaged when struck both in the front and on the side. When exposed to the side, the brittle edge of the pear-shaped opening can crack. With a strong impact, the nasolobic joint is broken, and the nose pyramid is shifted to the side. In addition to lateral displacement, there may be a bony abrasion and a flattening of the back of the nose. If the blow falls directly in front of the root of the nose, then the nasal bones in both their upper third may become occluded. There are also options such as subsidence of the nasal bones with the formation of a flat pad or the introduction of them between the frontal processes of the upper jaw [8]. The variety of anatomic features of the nose, undoubtedly, increases the number of FNB options for trauma.
Since criminal trauma remains a frequent cause of FNB, and clinically it is possible to diagnose only in half (55.3%) of patients, in many cases it is necessary to perform instrumental examination. Lateral radiography of the bones of the nose makes it possible to diagnose fractures in the region of the back of the nose (nasal bones). In the area of the lateral rays of the nose, the ultrasound of the bones of the nose is the more accurate method for diagnosing the FNB, since it allows to detect lateral displacement of the fragments. The most accurate method of investigation is computed tomography, which is indispensable for the diagnosis of combined fractures of the skull [9]. However, computed tomography can not be used as the final diagnostic mechanism for septal fractures. Differences between the results of X-ray studies and findings during surgery were found [10].
The prevalence of concomitant FNB fracture ofthe septum varies between 34% and 96.2%. Adequate treatment of such fractures is important for preventing complications such as posttraumatic nasal congestion and deformity of the nasseptal
FORENSIC EXAMINATION OF FRACTURES OF THE BONES OF THE NOSE
septum [11]. Fractures of the nasal septum in combination with simple injuries to the nasal bones are usually not recognized and remain untreated at the time of injury. Despite the fact that traumatic defects of the septum are diverse, there are certain patterns of displacement offragments, depending on the mechanism of injury, which can be clarified in 75.2% of cases [12].
Traumatic nasal injuries include a wide range of possible complications, prompt recognition and timely treatment are the key to good functional and aesthetic results [13]. FNB should be considered in conjunction with the subsequent consequences in the form of blood aspiration and asphyxiation. In these cases, SCPs cause serious damage to health. The decision of the question of deliberate infliction of harm to health or through negligence is in the competence of the investigative authorities [14]. To formulate a forensic diagnosis of FNB, accompanied by the ingress of blood into the respiratory tract, it is necessary to take into account the nature of the trauma (isolated or combined type of fracture). In addition, the presence or absence of concomitant damages and conditions is taken into account. From pathogenetic positions, a detailed analysis of the sequence and relationship of nosological forms and syndromes that could lead to the onset of a fatal outcome should be carried out [15; 16].
A feature of FNB is that they often lead to functional and aesthetic problems even after treatment. The most common facial cosmetic defects are associated with the consequences of FNB [17; 18]. Especially this problem is aggravated with combined injuries. Since the bony naso-orbital-etmoid complex is a three-dimensional brittle anatomical structure, damage to this region can lead to severe facial dysfunction and development of ugliness [19].
Injuries to the nose and perinasal area often occur simultaneously. With FNB, damage to adjacent structures, such as the orbit, the medial angle of the optic gap, and the skeleton of the middle zone of the face, can occur, they can be missed or misdiagnosed, leading to incorrect primary processing and subsequent secondary deformations. Three types of such traumas are widespread: nasomaxillary fractures, limited naso-orbit-lattice fractures, and severe central facial trauma with naso-orbit-lattice fractures [17].
Thus, forensic medical examination of FNB should take into account the nature and extent of damage, features of the anatomical structure of the bones of the nose, possible anomalies of their development, concomitant diseases, possible complications and consequences of trauma.
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