What is the Protocol for Fixing Newly Broken Nose?

The approach your surgeon will take with your nose will depend upon whether the fracture has displaced your nose and if so, how severely. A non-displaced nasal fracture can be observed and it will heal to the same shape it was prior to the injury. If your nose was displaced during the trauma, you will likely have to have the fractures reduced to straighten the nose.
The reduction procedure will also depend upon the degree of displacement you sustained. Your surgeon will decide and discuss this with you. My suggestion is to fix your nose before it heals, if all you want is to have the nose you had before your injury. If you are looking for cosmetic improvements, you can either do it at the same time as the fracture repair, or you may have to delay the surgery until the nose has healed enough to perform cosmetic rhinoplasty.

First an anatomy lesson. Only the upper one third of the nose is bone and can be broken. The lower 2/3 rd's is cartilage which is difficult to break. They are divided into acute or long term and simple or severe. Simple acute fractures can be set within 48 hrs. Severe acute fractures can be set from one day to two weeks after trauma but usually require a second nasal procedure with in six months. Long term simple or severe fractures can be repaired when ever the patient is ready and has time to heal. With all this being said , the condition of the septum also has to be diagnoses and considered. 

If the nasal bone fracture leads to a deviation of the nose then it needs to be pushed back in place (closed reduction of nasal fracture) within a week to 10 days. RegardsDr Janjua

The first thing is to be seen in the Emergency Room or by an ENT/Facial Plastic Surgeon to ensure there is no septal hematoma (i.e. blood trapped underneath the mucosa covering your septal cartilage).  If not diagnosed early, the cartilage will be without a blood supply resulting it dying/absorbing and the bridge collapsed.  This is an easy issue to address, but needs to be diagnosed early i.e. within the first 1-2 days after the injury.

Next is to be seen by an ENT/Facial Plastic Surgeon approximately one week after the trauma.  The reason is that a fractured nose is a clinical diagnosis (i.e. does it look crooked, off center, depressed, etc.) This can’t be determined for 7 days because of the swelling.  Swelling will fool the best of eyes the first week.  X-rays are of NO value in determining a fracture.  If a fracture line is seen on the X-ray, it still can’t tell the surgeon if that is a current fracture, or one from years ago.  The x-ray doesn’t tell the timing, and a CT is the same.

If it is determined that there has been a recent trauma, typically the surgeon will want to perform a closed nasal reduction within the 7-10 day period after the trauma.  During this time frame the swelling is gone, and the bones are now becoming “sticky” as they are starting to heal.  Typically, the patient is taken to the operating room for a very brief (10-15 min) anesthetic, during which time the bones are moved back into their previous anatomic state, absorb-able gauze is placed beneath the nasal bone and a metal splint is placed on the outside to help stabilize the bone to heal in the correct position.

Should the above closed nasal reduction not be successful, the patient is then taken back to the operating room at 6 weeks or any time thereafter to formally re-fracture the nose in a much more controlled manner using osteotomies (similar to delicate chisels) and then properly set with a splint.

Hope you found this answer helpful.  All the best!

If the result of your broken nose is a crooked appearance, the nasal skeleton may be repositioned to appear straighter. The key is to be evaluated by a reputable rhinoplasty specialist within the first two weeks following the trauma before the nasal skeleton heals and becomes fixated. Some nasal fractures are severe and surgical intervention may be warranted. Post-traumatic nasal surgery may be performed after all nasal and facial swelling has dissipated.Hope this helps.Dr Joseph

Nasal fractures occur frequently following facial
trauma.When patients have obvious or
displaced nasal fractures, they will usually require corrective surgery.Not all nasal fractures require treatment.In some cases, the bones and cartilage aren’t
displaced and because of this, surgery isn’t indicated.When
corrective surgery is performed within three weeks of the fracture, closed
nasal reduction is performed.This is a
relatively simple procedure that re-positions and stabilizes the nasal
bones.If repair isn’t done within three
weeks of injury, corrections need to be delayed for one year and then a formal
rhinoplasty performed.

Our protocol for a broken nose depends on the timing of the initial consultation. In some cases, it is important to reset the broken nasal bones under general anesthesia. If there is severe swelling, the swelling is allowed to subside before initiating any further surgery.

It is ideal to wait for the swelling to decrease, maybe a week or two and then perform a closed nasal reduction to reset the bones. Even doing this, there is 50% chance that you will need some sort of revision rhinoplasty later down the line. I like to wait 1 year before attempting the revision rhinoplasty.
Good luck.

There are 3 basic time points in which a nasal fracture can be repaired.
1) Within a few hours after the injury. This is due to the fact that the nose will start to swell, thus making it difficult to assess and modify the nasal contours and position.

2) After several hours and before 2 weeks. During this window, we wait until the swelling has come down and then re-set the bones into their appropriate position.

3) After 8 weeks. If the nose is not repaired within 2 weeks, it is required to wait until the nose has essentially healed prior to re-fracturing and re-setting it.

Keep in mind that it is possible a rhinoplasty will still need to be done as there are a percentage of the patients that will not get a "perfect" result and require a formal procedure.

I usually recommend against "immediate" reduction of a fracture for two reasons: 1) swelling--which occurs very quickly after a fracture--can obscure the actual curvature making accurate alignment difficult or impossible, and 2) "immediate" reduction usually means in the E.R. and not the O.R., so adequate pain control is usually impossible.
As for delaying the reduction, I usually like to treat patients after 5-7 days, but before 2 weeks. By two weeks, the bones are often beginning to heal in place and will require more effort and sometimes osteotomies (bone cuts) to get the nose adequately straight.
More significant problems can occur with delays beyond 4-6 weeks, since the bones themselves start to "remodel" and can take on permanent shape changes that require more extensive rhinoplastic correction.
After a fracture reduction, I do apply a cast to keep everything protected and aligned. The cast is removed in the office about a week later.
All the best,
--DCP