Hi I live in San Fran and had to go to the ER yesterday after I was hit in the nose; I got X-rays and diagnosed with an "acute nasal fracture". I was advised to go see a nose doctor in 5 days to remove the stitches and talk about the possibility of getting a surgical repair since my nose has shifted. How soon can I have the nose repaired? Would insurance cover the rhinoplasty portion as well? If not what would be the out of pocket cost for that portion (my ins coverage has always been good)?
How Long Before I Can Surgically Repair an "Acute Nasal Fracture"
Doctor Answers (13)
A broken nose should be reset as soon as possible.
A fractured nose with displaced bones should be reset as soon as possible (days). Because of the excellent blood supply in the face, the bones can reset in an unwanted position very quickly. Fixing the problem might then require refracturing which is more involved than simply reducing and setting a displaced fracture.
Nasal fractures should be reduced within two weeks of injury
Nasal fractures should be reduced within two weeks of injury. This typically involves a "closed reduction" where the nose is numbed (you might also be given some "twilight anesthesia") and the nasal bones are replaced to their position prior to your injury. With regard to your question about insurance coverage, closed reduction is often covered. I have experienced some situations where insurance would not cover closed reduction after 14 days following the injury (makes no sense, indeed). Followup with a plastic surgeon at 3-5 days when the swelling is beginning to resolve to assess what to do next.
Thank you for your question.
Stephen Weber MD, FACS
Acute Nasal Fracture
An acute nasal fracture should be repaired (reduced - the bones lined up) within 10 to 14 days after the injury. If it is not done immediately at the time of injury, it is best to wait 48 to 72 hours for the swelling to subside so the nasal contour is easier to visualize. Any rhinoplasty procedure that involves "cutting and breaking bones" should not be performed for at least six months after the initial closed reduction.
Insurance should cover the closed reductionof the nasal fracture after your initial injury, but you will need to check with your insurance company regarding pre-certification if you require a secondary rhinoplasty. The cost for a rhinoplasty varies depending on the complexity of the surgery. The average fee for a rhinoplasty in Washington, DC is around $6500.00
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Nasal fracture treatment in the first weeks after injury
- Sorry to hear about your injury.
- You should call your primary care doctor to get an urgent referral to a facial plastic surgeon or plastic surgeon. If you can self - refer, then call to make an appointment.
- As the swelling goes down, your surgeon and you can make a decision about a "closed reduction"
- If you have sutures, then it may be best to have them removed on the 5th - 7th day after injury.
When nasal fracture can be surgically repaired
An acute nasal fracture is best repaired after the swelling has subsided. The ideal time is between day 10 and 21 after the injury when it has been long enough for the swelling to resolve and allow your surgeon to accurately identify the crookedness of the nasal bones, but early enough that the bones have not healed crooked. This makes it easier to reposition the nasal bones back to the normal anatomical position.
Acute displaced nasal fractures
Acute displaced nasal fractures should be reduced within two weeks. My ideal time is ten days except a little sooner in a child and a little longer if there is massive swelling and bruise or lacerations. At that point the swelling is usually down so the reduction can be done with visual cues and by feel, and the bones usually stay in place nicely without packing or splinting. I generally do this in the office for patients who are comfortable with the office procedure - even 12 years old children. I like to see the patient as soon as possible after the injury to be sure there are no complications such as blood clot in the septum that can weaken the nasal structure..
Go see your doctor as soon as possible. There is a window where a closed reduction of nasal fracture can be performed. Generally, we wait 3 to 4 days after injury to allow the swelling to subside. We then have up to two weeks to have a closed reduction. This procedure manipulates the bones back to the pre-injury form, without making any incisions or being involved. If you wait longer than this golden period, manipulation becomes impossible since the nasal bones have already settled and started healing. You then have to wait 2 to 3 months for a more involved procedure. If however you would like a rhinoplasty performed with the nasal fracture it is best to wait 2 to 3 months at which time both can be performed. Your insurance company will only cover the non-cosmetic portion of the operation.
Surgical Repair of Acute Nasal Fracture
If x-rays showed a fracture it is located within the nasal bones. When the repair involves only repositioning of the bones without incisions it is best done within 2 weeks, before the bones start to fix. An open reduction and rhinoplasty can be done anytime after the gross swelling has resolved. Insurance companies will frequently pay for the rhinoplasty after a nasal fracture. Your surgeon will help you determine the insurance benefits.
Treating acute nasal fracture
An acute fracture is usually reset within the first 7-14 days. I would get in to see a nose specialist to get things checked out as soon as you're able to get in.
Insurance normally covers the fracture reduction procedure. Your surgeon's office should be able to give you a better sense of what would be covered.
The nasal fracture should be repaired if the nose has shifted within the first 3 weeks after the injury -- preferably between the 7th and 14th days post injury when most of the edema has gone down. If there is no cosmetic change, then nothing needs to be done. It's your insurance, call them to see if it will cover.