Can the doctor put a cast/splint of some sort to help it heal straight? If not, do I wait for it to heal and then seek plastic surgery to fix it?
What is the Protocol for Fixing Newly Broken Nose?
Doctor Answers (12)
Nasal Fracture Treatment
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.
Broken Nose Repair
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.
Fixing a newly broken nose
The protocol in our office for a broken nose repair is to formally reset the nose under general anesthesia. It took a lot of force to break it in the first place, and it needs to be set and realigned while asleep under general anesthetic. Most of the time when the outside of the nose is broken the internal septum is also fractured and crooked, creating a deviated septum. It is important to let the swelling to come down during the first two weeks prior to embarking on surgery to see how and where the nose is crooked. Additionally, spreader grafts can be performed with the patient’s own cartilage when the upper lateral cartilage of the nose is fractured off the nasal bone, creating a breathing issue.
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The nose should be evaluated as soon as possible after the trauma to rule out a septal hematoma (a blood clot within the septum) which could cause permanent damage to the nasal structure. If present the hematoma should be evacuated immediately. If not, wait about 10 days to determine if there has been a change in nasal appearance or breathing obstruction. If neither has occured, treatment of the fracture is not necessary. With deviation of the nasal bones, they can be manually repositioned without making incisions within the nose. If it is determined there is more severe injury with breathing obstruction or displacement of the cartilagenous structures I would do a comlete rhinoplasty to reduce the fractures. Timing depends on the severity of the injury.
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.
Nasal bone fracture
A splint will not help it heal straight. If the nose is crooked it must first be reset to straighten it. If the nose is not reset with in the first 10 days, as the nasal bones can be shifted during this time, then usually it is best to wait 3 months.
Timing of nasal fracture repair.
There are 3 basic time points in which a nasal fracture can be repaired.
Fix broken nose within ten days or wait eight weeks
The nose must be evaluated on two fronts: breathing and external appearance.
Assuming there is not major blockage preventing breathing, which is the only bonafide broken nose emergency, either the correction of breathing/appearance is done within the ten days after injury or one waits to operateuntil the bones have welded together, which is usually by eight weeks later.
The cosmetic nasal surgery specialist must perform a complete evaluation at the time of consultation after the accident. Must evaluate the degree of injury to the internal and external support structures. Must also evaluate the swelling since you cannot do the best work until the swelling goes down; typically that is within one week.
After ten days, that first window of repair opportunity is lost because the bones start to heal in whatever position they are in. So, the surgeon waits until the next appropriate time which is at the eight week mark by which time the bones are solid enough to be re-positioned.
You must understand that often, despite the best talent, there is a need for a touch-up after the original procedure, whether within that first window or later. This is because Nature can be unpredictable and set down some extra bone which might present as a little bump that was not present prior to the injury.
Finally, it is helpful to the surgeon if you bring photos of your appearance prior to accident. The doctor needs to know what your nose was like orignally.
3 times for correction
I fix broken noses at three different time - 1 at the time of injury if there is little swelling - if swolen, I wait 7 to 14 days and do a closed reduction. If you have waited longer than 2 to 3 weeks before seeing a doctor, I wait until it heals and then fix it with and open reduction at 3 months.
Timing after a nasal fracture is important.
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,
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.