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

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