My son was in a bicycle accident on Saturday and I am pretty sure he broke his nose. There was a TON of blood and swelling started immediately. I am now (its now Monday) becoming concerned that maybe he fractured something else in his face. His left eye is almost swollen shut and black all over his left side of face. Should I wait to take him until the swelling es down or shoud I take him right away? Any advice would be greatly appreciated!
10 Year Old Bicycle Accident and Possibly has Broken Nose, Should I wait Until Swelling Goes Down to Take Him in?
Doctor Answers 8
Should I have my son evaluated
I would take your son in for an evaluation as soon as possible. You will likely need to go the ER for a workup. Part of the workup will likely involve a maxilofacial CT scan. If the scan reveals fractures you will likely be referred to a facial plastic surgeon. Depending on the severity of the fracture, it is possible to reduce a nasal fracture simply by shifting the nasal bones back into the midline and putting a cast on it. This can be done if the fracture is simple and if it is performed within about 10 days of the accident. The most important thing is to get it evaluated as soon as possible.
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He should be medically evaluated and ideally should get a CT scan of the face to look for possible facial fractures. If the nose is fractured but not displaced there is no emergent need for surgery
I would take him either to a plastic surgeon or the emergency room. It sounds like he may have other facial injuries, and he would probable a CAT scan done. If you take him to the ER, they will be able to get a Cat scan right away and notify a plastic surgeon regarding any fractures other than the nasal fracture. From your description he needs a CAT scan done anyway, so it makes the most sense to be evaluated first in an ER, get the CAT scan, then be referred to a plastic surgeon if necessary.
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When should you seek a plastic surgeon following facial injury?
When should you seek a plastic surgeon following facial injury? Although it has only been a few days and the swelling is still significant, I would recommend seeking a facial trauma surgeon (Facial Plastic Surgeon, Plastic Surgeon, Oculoplastic Surgeon) for evaluation. It is possible that there is only soft tissue trauma and swelling but an in person consultation will determine if there is any bony injury. Your son might require imaging (CT scan) based on that evaluation. If there are facial fractures, most should be fixed within two weeks. Also if there is a nasal fracture it can be "reduced" in the office with a small amount of sedation within a two week window. If the fracture heals it will require a surgical procedure to repair which is obviously much more invasive with more downtime. For these reasons, your son should be seen sooner rather than later.
Thank you for your question.
Stephen Weber MD, FACS
Depending on your insurance, you may want to start with your pediatrician
From your description, I agree with all the other comments that you should take him for evaluation.
- If the mechanism of injury caused that much bruising and bleeding, he should see a facial plastic surgeon or plastic surgeon this week.
- His pediatrician could order a CT scan before the surgery consult.
If the nose is broken and needs to be set, it needs to be done within the first 3 weeks. Don't wait any more = go see a plastic surgeon
If a broken nose is suspected, the patient should be seen as soon as possible.
If the nasal bones are displaced from a fracture, as time passes they will become secure in their new (and unwanted) location. Before this occurs, the surgeon can manipulate the bones closer to their original location to minimize any cosmetic deformity.
Possible nasal fracture
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