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 19
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.
Closed reduction of an acute nasal fracture
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
Fixing nasal fracture
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.
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After a nasal fracture, if the injury is less than 7-10 days old there may be an option a reduction, where the bone is literally pushed back into place. This can only be done early, before the forces of healing occur to fuse the bone fragments. However after this 2 week window the chances of successful reduction go down.
Even after some of these reduction/splintings, the nose can still look crooked or breathing can be affected. After at least 6 months from injury, a formal rhinoplasty or nosejob can be done which can definitively improve the appearance. The important things to tell your doctor are whether the nose appears different or breathing is affected.
How to treat a newly broken nose
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!
In many cases a newly broken nose may be repaired with local anesthetic in an office setting.
Broken Nose Treatment
However, in my practice I have reduced nasal fractures at every possible time - immediately, 2 days, 2 weeks, 2 years, 20 years! The primary difference is that if the bones have healed, then the fracture lines need to be recreated by "re-breaking" the nose. I have not noticed any difference in the outcomes of these different groups, in my hands.
A surgeon who performs frequent rhinoplasty would find this to be a routine and relatively minor procedure. A general ENT doctor or plastic surgeon who does not perform frequent rhinoplasty, however, may find this to be a challenge.
I always prefer to see a patient with a nasal fracture as soon as possible. That keeps all the options open for them and gives the best chance for the best result.
Seek attention sooner rather than later!
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, corrections need to be delayed for one year and then a formal rhinoplasty performed.
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.
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.
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.