No CT Scan Done After my Accident and Missed the 7 Day Window for Reduction, What Now?

As other rhinoplasty and plastic surgeons stated, generally a CT scan is not required to diagnose a broken nose. A office visit with a surgeon will help determine the broken nose.

Fixing a broken nose is commonly performed early after injury, while the bones are still loose or mobile. Minor nasal injuries may not require surgical broken nose repair, with treatment being rest and observation. If there was no change in the appearance of the nose or nasal breathing, then surgery would not be necessary despite what a CT scan may demonstrate. Broken nose repair or closed reduction is relatively easy and sometimes performed in the office with local anesthesia. After a few weeks, the bones have become too stiff for a closed reduction and will require some form of rhinoplasty, including an open reduction.

Only after a comprehensive evaluation can a surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

 

An isolated nasal fracture can be diagnosed in most cases using a careful exam and clinical history. CT scans can find clinically insignificant fractures that don't need to be repaired. What really matters is whether there is an external deformity and/or new deviation of the nasal septum.

In many cases a closed reduction while the nasal bones are still mobil is the most straightforward method of repair though there can be issues of persistent deformity due to cartilage memory, etc. Delayed rhinoplasty can be used to obtain more consistent results though surgery is more complicated.

In general, a experienced rhinoplasty surgeon would not request a CT scan unless other facial injuries are suspected. Nasal injuries can usually be accurately diagnosed by a careful physical exam alone. A closed reduction of a nasal fracture can be done in the first 2 weeks, but becomes more difficult after that time. Waiting for the bones to heal after that will make correction more predictable when surgery does come around.

Nearly two years ago, I gave a lecture to the ENT residents at the New Jersey Medical School titled: Contemporary Management of Facial Fractures. After trauma, CT scans are needed if there is suspicion of a traumatic-brain-injury or a facial fracture.

Isolated nasal fractures, however, are diagnosed with a history and physical examination. When your nose is fractured, there may be nose-bleeding, impaired nasal-breathing, bruising under your eyes, nasal tenderness, and a change in your nasal appearance. Most patients have closed or open reductions of their nasal-septal fractures if there is a change in the appearance or function of their noses. This is typically evident within the first two weeks after trauma when such procedures may be prudent. In my opinion, facial x-rays or CT scans do not change the way I manage most isolated traumatic nasal injuries.

Hope this is helpful, and good luck with your upcoming surgery.

Dr. Joseph

 

The decision making after nasal trauma is not based on imaging. A CT scan may show fractures that are clinically not important. It is the hands on examination that is important. Is there a deformity not previously present, airway obstruction, etc. Closed reduction maybe attempted up to 7-10 days but I agree with Dr Fleming (see below) that usually a rhinoplastic approach will yield better results.

If patients come to to me early within 1-2 weeks after their accident, I try to perform a closed reduction and then commonly have to do something in 6 months or so to reduce the dorsal hump.  But it is always easier if one can recentralize the nose in the acute phase.

 CT scan to evaluate a nasal fracture is way over the top IMHO.  Any experienced Rhinoplasty Surgeon should be able to diagnose a potential nasal fracture without one.  Closed nasal reductions (I did many during my training at LAC/USC) are not effective so in my mind you missed nothing.  A closed Rhinoplasty is typically performed at 3-6 weeks after the nasal trauma once the tissues have healed.  There's no reason to wait 9 months unless you're uncertain about wanting the Rhinoplasty at all.  

After 10 Days a nasal fracture will be difficult to reduce after 2 weeks the surgeon will typically need to re-fracture the bone.All of the above needs to balanced against performing surgery with post traumatic swelling .

It is not necessary to order CT scan to diagnose a nasal fracture. This is done on the basis of a careful physical examination. If there was no change in appearance or function, surgery would not be necessary despite the diagnosis of fractures after a CT scan. A closed reduction of nasal fractures is easier but not as reliable as an open procedure and therefore the results are less predictable.