Closed Reduction for Slight Nasal Fracture?

Question

I had small nasal fracture and septal deviation from an errant arm in a soccer game two days ago. It is hard for me to tell if it has affected my breathing because I also have had a cold prior to and after the game as well. I wondered if there were any suggestions as to how to best evaluate it prior to making a decision. Should I try to completely clear my sinuses through a nose pot or hot peppers to better evaluate any breathing irregularity? I have also included photos. Thanks for any help.

Larry S. Nichter, MD, MS, FACS · Answer

Nasal trauma that deforms the nowe should be examined by a Plastic Sugeon or ENT/ facial plastic surgeon to see what has been injured, that there is no septal hematoma that may have to be evacuated, and to evaluate if there is a nasal or septal fracture. It is far easier to repair any injured cartilage or bone displacement in the first few weeks following an injury.

John Philip Connors III, MD · Answer

Hello Tampa Paul-

	Rough soccer game....I assume you were evaluated in the ER and an MD diagnosed the small nasal fracture and septal deviation? Unfortunately, I think it is probably in your best interest to see a Board Certified Rhinoplasty Surgeon and have them evaluate whether or not you truly do have a fracture and a septal deviation...the deviation could be swelling from a septal hematoma which would need immediate attention and can be drained by the surgeon. I like to see patients with a similar history to your ASAP, because I can assess the septum and treat it as need, and also set the fracture before it forms scar tissue and "locks" the malpositioned bone in an abnormal place. Earlier the better...get on-line and find a surgeon specializing in Noses.

	Hope this helps!

	Dr. C

Paul S. Nassif, MD · Answer

Hello,

	 It is difficult to determine whether or not your breathing is affected by the trauma you experienced. An examination would be necessary to provide you with any advice. If the nose is straight, a closed nasal reduction will not be necessary. If you wish, please feel free to schedule a consultation with my office and I would be happy to evaluate your nose. Thank you, and good luck to you.

	Dr. Nassif

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Your nose does not look bad in this picture.  What I usually do is allow the swelling internally and externally resolve of 7-10 days then re-evaluate the need for surgery.  That's my advice.

	Dr. ES

Kevin Sadati, DO · Answer

Dear Paul with nasal fracture from Land O Lakes, FL
	I reviewed your post injury photo. It is difficult to evaluate your fracture or degree of injury to your nose by looking at this picture. A displaced nasal bone and septum as result of injury can be easily diagnosed by direct nasal evaluation and nasal X-Ray. If your surgeon suggested a closed reduction, you may want to do this procedure rather than waiting for a few weeks to have a more complex surgery. For simple displace nasal bone fracture closed reduction and internal fixation is an excellent option. Remember you have only one week window period after initial injury to have this procedure

Edward J. Gross, MD · Answer

It is best to be evaluated within 4 weeks of a nasal fracture. We can often perform a closed reduction (without the need for surgery) during this time frame. X-rays are not needed. I do not foresee the need for Septoplasty in your case. A board certified Rhinoplasty surgeon is your best option. Medi pot may help clear you up in a few days, but you should seek an expert to examine you and make recommendations. Dr. Gross, Orlando.

William Portuese, MD · Answer

We no longer perform closed reduction of nasal fractures because of the recurrence of the fracture. We perform an open reduction for nasal fractures, which includes osteotomies. Many times after the injury there is a septal deviation that needs to be corrected. If the nose is crooked from the external view, it needs to be reset formally. This can be done as a primary operation or in conjunction with a septoplasty if needed. It is important to wait approximately two to three weeks after the injury to make any final determinations whether or not the nose is indeed crooked.

William A. Wallace, MD, FACS · Answer

Early evaluation by a Board Certified Plastic Surgeon is the best way to determine if closed reduction of a nasal fracture would benefit you. 

	Your symptoms are unfortunately not specific enough to warrant it. Your picture is helpful, but an internal nasal examination would be most beneficial. 

	The sooner you are seen the higher the success rate with closed reduction techniques.

Houtan Chaboki, MD · Answer

Hi Tampa Paul,

	Broken noses are extremely common. Nose bleeding & nasal deviation are the more common signs of bone fracture. Breathing irregularity is typically not the best method to determine nasal injury, as swelling occurs both on the outside and inside of the nose. Treatment is generally recommended after a short waiting period from the initial injury, to allow resolution of some the swelling. Typically nasal fractures are repaired about 1-3 weeks after injury.

	Co-existing allergies, common cold, or sinus infection may worsen the nasal congestion symptoms after the injury. One should see a nasal specialist after injury to be evaluated to help determine if (1) your nose is broken, and (2) timing of repair.

	Broken noses may be treated in the office via local anesthesia, or alternatively in the operating room under general anesthesia. More commonly the procedure is a "closed reduction" where the nasal bones are simply repositioned back to their original position. Occasionally, the nose needs to be re-broken to align the bones properly. Septoplasty, or surgery on deviated septum, sometimes may also be performed at the same time. Only after a comprehensive evaluation can a nasal surgeon help determine appropriate options for you. Best of luck.

	Dr. Chaboki

Gary D. Breslow, MD, FACS · Answer

I would wait at least 4-6 weeks before evaluating if you have any real changes in breathing.  There is no rush to do anything.

Closed Reduction for Slight Nasal Fracture?

Answers (14)