What is the Protocol for Fixing Newly Broken Nose?

Thank you for this great question which many patients contemplating or undergoing this procedure are sure to ask. Generally, a newly sustained (acute) nasal fracture should be "reduced" or fixed if it is associated with a significant cosmetic deformity or deviation or if nasal breathing is compromised as a result. The timing of the procedure is typically within 24-48 hours before the swelling kicks in, or at the 7-10 days mark (sometimes up to 14 days) when most of the swelling has subsided. The procedure, which is entitled closed reduction with external stabilization, entails physically manipulating/moving the broken bones with a blunt surgical instrument to restore them in a more correct anatomic location. This is done under general anesthesia or sedation anesthesia depending on your surgeon's preference and the nose is anesthetized so no pain is felt during the procedure. A splint is then placed over the nose, which gets removed approximately 1 week later. A closed reduction is a quick and well tolerated procedure with minimal post operative swelling and bruising (beyond what is already present from the injury), and the likely first step to manage an acute nasal fracture. The vast majority of patients do not seek any additional surgical treatment after their closed reduction. If a proper reduction is unsuccessful via closed reduction then it is reasonable to consider a more involved surgery 6 weeks-3 months later, at which time other issues such as a deviated nasal septum could be addressed simultaneously. Hope this helps! Best, Dr. Roy 

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!