No CT Scan Done After my Accident and Missed the 7 Day Window for Reduction, What Now?

asked 5 months ago by YRH
Latest answer by Houtan Chaboki, MD
Question viewed 158 times
Tags: options, timing

closed reduction. Now we are planning a closed rhinoplasty for 9 months post injury. Would a CT scan right after my accident prevented this outcome. Is closed reduction an easier procedure compared to rhinoplasty? Generally what are the typical outcomes and average costs on both these procedures? In my case, a ct scan done 21 days post injury revealed fractures, compressed nostril, displacement, and a bone fragment. Now waiting for rhinoplasty to repair it all. Opinions please?

9 answers to No CT Scan Done After my Accident and Missed the 7 Day Window for Reduction, What Now?

No CT Scan Done After my Accident and Missed the 7 Day Window for Reduction, What Now?

CT scan to evaluate a nasal fracture is way over the top IMHO. Any experienced Rhinoplasty Surgeon should be able to diagnose a potential nasal fracture without one. Closed nasal reductions (I did many during my training at LAC/USC) are not effective so in my mind you missed nothing. A closed Rhinoplasty is typically performed at 3-6 weeks after the nasal trauma once the tissues have healed. There's no reason to wait 9 months unless you're uncertain... more

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon

drfrancispalmer.com

Closed reduction or closed rhinoplasty after nasal injury and broken nose

As other rhinoplasty and plastic surgeons stated, generally a CT scan is not required to diagnose a broken nose. A office visit with a surgeon will help determine the broken nose. Fixing a broken nose is commonly performed early after injury, while the bones are still loose or mobile. Minor nasal injuries may not require surgical broken nose repair, with treatment being rest and observation. If there was no change in the appearance of the nose or nasal breathing, then surgery would not... more

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon

CT scan not needed to diagnose a nasal fracture

An isolated nasal fracture can be diagnosed in most cases using a careful exam and clinical history. CT scans can find clinically insignificant fractures that don't need to be repaired. What really matters is whether there is an external deformity and/or new deviation of the nasal septum. In many cases a closed reduction while the nasal bones are still mobil is the most straightforward method of repair though there can be issues of persistent deformity due to cartilage memory, etc.... more

Thomas A Lamperti, MD
Seattle Facial Plastic Surgeon

www.drlamperti.com

CT scan after nasal trauma

The decision making after nasal trauma is not based on imaging. A CT scan may show fractures that are clinically not important. It is the hands on examination that is important. Is there a deformity not previously present, airway obstruction, etc. Closed reduction maybe attempted up to 7-10 days but I agree with Dr Fleming (see below) that usually a rhinoplastic approach will yield better results.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon

Nasal injury

After 10 Days a nasal fracture will be difficult to reduce after 2 weeks the surgeon will typically need to re-fracture the bone.All of the above needs to balanced against performing surgery with post traumatic swelling .

Jay M. Pensler, MD
Chicago Plastic Surgeon

www.plasticsurg.org

Nasal fractures

If patients come to to me early within 1-2 weeks after their accident, I try to perform a closed reduction and then commonly have to do something in 6 months or so to reduce the dorsal hump. But it is always easier if one can recentralize the nose in the acute phase.

Steven Wallach, MD
Manhattan Plastic Surgeon

CT Scan after Nasal Fracture

It is not necessary to order CT scan to diagnose a nasal fracture. This is done on the basis of a careful physical examination. If there was no change in appearance or function, surgery would not be necessary despite the diagnosis of fractures after a CT scan. A closed reduction of nasal fractures is easier but not as reliable as an open procedure and therefore the results are less predictable.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

CT Scan after Nasal Injury

In general, a experienced rhinoplasty surgeon would not request a CT scan unless other facial injuries are suspected. Nasal injuries can usually be accurately diagnosed by a careful physical exam alone. A closed reduction of a nasal fracture can be done in the first 2 weeks, but becomes more difficult after that time. Waiting for the bones to heal after that will make correction more predictable when surgery does come around.

Ira D. Papel, MD
Baltimore Facial Plastic Surgeon

In general, facial CT scans are not necessary to diagnose isolated nasal fractures.

Nearly two years ago, I gave a lecture to the ENT residents at the New Jersey Medical School titled: Contemporary Management of Facial Fractures. After trauma, CT scans are needed if there is suspicion of a traumatic-brain-injury or a facial fracture. Isolated nasal fractures, however, are diagnosed with a history and physical examination. When your nose is fractured, there may be nose-bleeding, impaired nasal-breathing, bruising under your eyes, nasal tenderness, and a change in your... more