Waiting Before Having Broken Nose Fixed?

Question

I broke my nose almost 3 weeks ago while out of town. I have been told by the ENT that I will now have to wait 3-6 months for surgery to straighten it with a plastic surgeon. Is this true?

Richard J. Bruneteau, MD · Answer

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, bone healing has usually progressed to the point where formal rhinoplasty is necessary to correct the problem.  This should be delayed for at least six months to allow stabilization of the boney nasal structures.

William Portuese, MD · Answer

There is no reason to wait six months to have a broken nose corrected. Repair of the nose can be done at any time one week after the injury when the severity of nasal crookedness is visible. The nose is reset through placement of medial and lateral osteotomies. Any fracturing of the upper lateral cartilages off the nasal bones need to be corrected with spreader grafts. Internally, the septum is usually fractured off the vomer and the perpendicular plate of the ethmoid; these issues will also need to be addressed at the time of surgery.

David C. Pearson, MD · Answer

Waiting three to six months seems like bad advice. While I usually recommend against "immediate" reduction of a fracture, 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.
All the best,
--DCP

Richard W. Westreich, MD · Answer

I would try to get a closed nasal reduction within the week. It can often still be done as far as 1 month after an injury if the bone has been shifted significantly.
I would then wait the 3-6 months proposed to see if additional corrective procedures are needed. Usually, they are not.
Good luck

Tanveer Janjua, MD · Answer

After a broken nose that needs surgery to straighten it, you can have it done as soon as you want. The reason we like to wait for a few days (3 to 5days) is to let the swelling go down to have a better idea of how bad the nose looks. There is no advantage to wait longer than one week after the injury.
Regards

Michael A. Persky, MD · Answer

Hi Chi,
Best to reset the bones of a nasal fracture within the first 10 days, the latest is about 18 days, at which time the bones have formed callus (they are healing back together).  Early on, the bones can be reset without any incision (closed nasal reduction).
 Many of us then recommend about 4 to 6 months to allow all of the healing forces to settle before rebreaking the bones and straightening the nose.  If done sooner, studies have shown that  there may be a higher revision rate because of those scar tissue healing forces.
At least you will be able to make up some creative stories about your nasal fracture in a city like Chicago (Blackhawks, Bears, City Organizers).
Good luck and be well.
Dr. P

Houtan Chaboki, MD · Answer

Yes, and no.
A broken nose should be fixed within a month after the injury. Depending on the exact nature of the fracture, most broken noses are treated within 2 weeks of injury. I've treated broken noses up to 1 month after injury. You can't wait much longer, otherwise the bones fuse in their new position.
Most plastic surgeons or otolaryngologists will fix a broken nose by realigning the nasal bones. The procedure is relatively simple. Broken nose repair may be performed under local anesthesia in the office or IV sedation / general anesthesia in the hospital.
However, persistent asymmetry, bumps, deviations, or twists may still persist after this initial treatment. A patient will have to wait several months before further plastic surgery on the nose is performed.

Steven Wallach, MD · Answer

If the nose is signficantly deviated, I like to wait a few days after the accident before taking the patient to the operating room to reduce the fracture. I tell all patients that they should expect an additional procedure in 6 months to a year later to remove minor irregularities such as bumps on the nose that can not be treated at the time of the fracture reduction. At 3 weeks after your accident, it is likely that the bone has already begun to heal and will make it very dificult to mobilize it.

Robert Mounsey, MD · Answer

The nasal bones are paired structures located below the frontal bones in the midline.  They are thick in the upper portions and thinner in the lower portions.  They are frequently injured by facial trauma.  Management  of nasal fractures is complex.  
If an injury occurs and is recognized immediately (cracked nose on the football field), the nasal bones can be reduced (realigned) immediately with excellent results.  If the injury is recognized later there may be a great deal of swelling and it may be hard to obtain a good result with closed reduction (fixing the break without incisions).  
If the bones have begun to heal, it may not possible to get a good closed reduction and many surgeons may wait until the bones have healed and the swelling resolved before attempting correction (this may be 6 weeks).
Therefore the management varies based on the extent of injury and the time that the patient presents.  My best advice is to seek a consultation with a surgeon experienced in nasal fractures.  He can then review your xrays (if done) , examine your nose and discuss the option that best suits your needs.  
Best of luck

Richard W. Fleming, MD (retired) · Answer

This long after the fracture,  I recommend waiting another 6-8 weeks and then proceeding with definitive repair of  the damage. I do not agree with the need to wait  6-8 months for surgery.

Waiting Before Having Broken Nose Fixed?

Answers (10)

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