How Do You Know if Cartilage Has Warped?

Question

I had a Rhinoplasty/Septoplasty and Nasal Graft surgery 9 weeks ago to help me with a breathing problem I had. I had a slight bump to my nose at 7 weeks post operation. I am worried my nose is ruined. I went to see the doctor and he said everything is fine, but when I don't feel fine. I feel like there is something in my nose that moved? I think cartilage might've warped. How do you know? Thanks

Richard H. Tholen, MD, FACS · Answer

Without being overly simplistic, I think the answer to your question is similar to the answer I give patients when they ask if their nasal trauma has caused a nasal injury. My reply is that scans and X-rays aside, there are two basic functions of the nose to consider (3, if you include the sense of smell, but that occurs high inside the nose at the base of the brain):

	
		Breathing (the nose allows respiration, and injury or deformity can cause airway obstruction for which surgical correction is needed)
	
		Appearance (if it looks crooked, then to straighten it will require surgery)


	So, if you bump your nose (surgery or not) or "catch" a softball with your nose and wonder if there's an injury, the knee-jerk response, even by many doctors, is to request an X-ray, CT scan, or MRI scan.

	But what is really needed is to simply assess appearance and function. Of course, an injury can cause bruising and swelling, and those things can obscure deformity and impair function that will return to normal once swelling is resolved. So it's not wrong to obtain scans or X-rays, it's just often unnecessary in the absence of other concerns.

	In other words, if the nose looks fine (minimal swelling), and works fine, then even if an X-ray showed a fracture, nothing needs to be done. Even if an X-ray appears normal, there can still be cartilage and soft tissue injury causing crookedness and deformity, and I don't need an abnormal X-ray or scan to tell me the patient's nose requires straightening or repair.

	The same applies here. You bumped your nose and wonder if it's OK. Perfectly natural concern and worry. Here's how to see if it's OK. Let any swelling (if any) resolve, and then see how it looks and how it "works." If both are OK, then your graft and surgical procedure has been left undamaged. If there is swelling, you have to be patient, and then check things out. And you don't need your surgeon to do this--you can do it yourself! See how your nose looks and works, and if all is well, then your surgical result is unchanged from where it was before the "bump."

	Since you feel something has "moved," you have to determine if this is localized swelling or bleeding that will resolve on its own, possibly a bit of scar tissue with increased swelling, or if in fact your graft has moved. The latter is unlikely at 9 weeks post-op since tissues are firmly adherent by that time, but not impossible.

	So, give it a bit of time, see how your nose looks and works, and there is your answer! Best wishes! Dr. Tholen

Vincent N. Zubowicz, MD · Answer

Your nose may not turn out the way you wish but one would not expect any warping of cartilage in nine weeks. Continue to follow up with your plastic surgeon and carefully express your concerns about the nose.

Richard J. Brown, MD · Answer

This is mainly diagnosed by physical exam by your surgeon. Remember, things are going to feel different and you will need many months to get used to the changes. Being that said if you truly feel something has happened then go see your surgeon for an exam. If they are not telling you what you want to hear then either you have to trust in them or seek another opinion. My hunch is you just need to give this time. You are still very early in the post operative period and I think in time you will  see that things will settle down. If they don't then you deal with it at that time, but I would wait a minimum of 6 months before you really worry.

Robert Brobst, MD · Answer

Thank you for sharing your concerns. You are still very early after rhinoplasty and warping is unlikely. Also, if the only cartilage that was utilized was septal cartilage you have very little risk. It inherently has little tendency to warp. Alternatively, ear cartilage starts curved and tends to stay that way. Rib cartilage (autogenous costal cartilage) does have a higher chance of warping unless it is carved correctly and partially allowed to declare itself prior to placement in the nose. In the hands of an experienced surgeon, this can be used with reliable results. Overall, you should share your concerns with your surgeon and be patient. I hope this helps. Take care.

Francis R. Palmer, III, MD (retired) · Answer

The nose becomes crooked or asymmetric indicating that the grafts used during Rhinoplasty are dissolving, shifting or otherwise changing which affects the nasal contour and shape.

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