How Difficult is It to Fix Broken Nose Tip?

Question

4 years ago, I was in an car accident hitting my nose (bottom/tip area) very hard. I didn't think it was broken at the time; the bone felt straight and I had no bleeding at all (but a lot of swelling.)
A few years later, I can see that the tip of the nose definitely goes off to the right side a little in a face-on view.  It seems I must have displaced/broken the cartilage of the lower nose (septum?) without breaking the upper part or bone. How difficult would this be to fix? Thank you!

Rian A. Maercks, MD · Answer

Your complaint is a common one after septal injury, fracture or hematome.  This is a relatively common problem.  In general several steps are required to reverse the twisting caused by post traumatic healing/scarring.  Firstly a separation of components must be performed.  This means separation of the four major shaping cartilages from eachother and from the septum.  Once they are relieved from the scarring and pressures exerted on eachother they can be assessed for form and needed interventions.  the next step is to relieve distorting pressures from the central septum.  this is achieved with what is commonly referred to as a submucous resection.  the central septum is removed leaving the structurally important parts intact.  sometimes this intervention alone is enogh to straighten the nose and repositioning of the four major cartilages is all that is necessary.  Other times, the removed piece of septum must be carved into batton grafts and sewed to the septum to straighten it.  Additional grafts may be necessary to achieve adequate and centralized tip projection.  A well trained plastic and reconstructive surgeon should be able to deliver you beautiful results.  I hope this helps!

	 

	 

	All the best,

	 

	Rian A. Maercks M.D.

Eric M. Joseph, MD · Answer

If the tip of your nose is deviated after nasal trauma, it could be from a septal fracture. You should consult a board-certified, experienced Rhinoplasty specialist to diagnose your problem, and make specific recommendations.
I hope this is helpful for you.

Scott Trimas, MD · Answer

A crooked tip can result from either nasal trauma or can even be congenital in nature. It is a little bit more difficult to fix than the classic broken nose involving the nasal bones. Depending upon the extent of your injury, you may need the cartilages of the lower third of your nose reshaped or it may be just a manner of fixing the crooked septum which is pushing the lower third of your nose. In complicated situations, grafts may be required from the septum itself to camoflauge any irregularities. I hope this information helps.

Steven J. Pearlman, MD, FACS · Answer

The typical broken nose usually describes breaking the bones, which comprise the upper 1/3 of the nose. Fixing this is a relatively straight forward procedure. Angulation of the lower 2/3 of the nose can also occur from trauma but is a little more difficult to correct. We often use grafts of your own cartilage, preferably septum cartilage, to help "shore up" the crooked cartilage. I suggest you seek out a rhinoplasty specialist for an opinion on what it will take for you to get a straight nose.

Michael A. Persky, MD · Answer

Hi Rebecca,
It sounds as if you have a deviated nasal septum from your description of your injury and subsequent crookedness of your nasal tip.
Fortunately you don't need to worry about the difficulty of the repair, you just need to find a rhinoplasty surgeon who is excellent at correcting your problem.  The difficulty of the surgery depends upon the nature of your deformity which can only be determined after examining your nose.
Degree of difficulty will be important in the upcoming Vancouver Winter Olympics, but in rhinoplasty it is important to choose a skilled and experienced surgeon.
Good luck and be well.
Dr. P

Philip S. Schoenfeld, MD, FACS · Answer

It sounds as if you damaged the cartilage of your nose at the time of your injury. You do not need to break the bone of your nose to have subsequent deformity of the nasal tip following an injury.
Although the discomfort of rhinoplasty is not quite as significant if no bony work needs to be performed, fixing a deviated nasal tip is generally a challenging procedure for the experienced rhinoplasty surgeon. The cartilage has memory and your tip has the propensity towards being bent towards the right. Your surgeon will need to straighten the cartilage and further support the tip to prevent eventual re-curvature back into the position it is currently in. 
The problem may not only be your septum, but the lower lateral cartilages may also be deviated and will need straightening. Not terribly complicated, but, definitely tricky.

Jon F. Harrell, DO, FACS · Answer

It is quite possible to dislocate or otherwise injure the cartilaginous septum or tip cartilages without fracturing the nasal bones. It could certainly present in the fashion you are describing. A thorough examination should be able to determine what is causing the problem and surgery should most likely be able to improve the situation although warping of the cartilage can sometimes make the surgery technically more difficult. Best of Luck

William Portuese, MD · Answer

It is certainly common to fracture cartilage independently of the nasal bones during an accident involving the nose. This can cause the nasal tip to be twisted and appear very asymmetric. The septum and tip cartilages can be broken, twisted, and warped over time from a nasal injury. Very frequently structural cartilage grafts are harvested from the inside of the nose and placed internally to augment the twisted portion of the nose to create more symmetry. This also usually allows for better breathing. Occasionally, the nasal bones will need to be broken as well if they are twisted and fractured.

Sigmund L. Sattenspiel, MD · Answer

A skilled rhinoplasty surgeon should be able to correct the displaced or deformed nasal tip, whether or not it is from direct trauma. 
If there is no displacement of the nasal bones, they do not have to be broken (osteotomies). However, the upper half of the nose where the nasal bones are present will remain unchanged. 
In certain circumstances, it may be desirable to perform osteotomies of the nasal bones in order to better realign the nose. In your case, this may not be necessary and the work would strictly involve the cartilages of the nasal septum as well as the nasal tip.

Steven Wallach, MD · Answer

Correcting a deviation sustained from a broken nose can be accomplished by a board certified plastic surgeon. This is a very common procedure. Like you said, it sound like a septum that may have fractured.

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