Hit hard in nose about 2 wks ago from the side. Do I need surgery ASAP to repair or wait? Will it heal without surgery?

Question

Nose swelled more on 1 side, front teeth hurt & top lip swollen = went to dr. Note: rhinoplasty 15+ yrs ago to repair deviated septum, no issues until now. CT SCAN – Mild deformity of bilateral nasal bones – Superimposed fracture cannot be excluded – Reduction of nasal valve angle bilaterally, left greater than right – Mild-to-moderate deviation of nasal septum to left NOW: Still in pain & issue breathing from one side of nose. - Are there options besides taking ear cartilage to repair nose?

Ronald J. Edelson, MD · Answer

Photos would be helpful in evaluating your case.  If you do require surgery, you don't necessarily need a cartilage graft. It depends on what the specific problem is and that would require an in person exam. Unless your nose is obviously crooked from the injury, you should wait until the swelling resolves.  If it is crooked, then the bones have been broken and it should be straightened, but that should not require a cartilage graft.

Toby Mayer, MD · Answer

An exam is needed to see if this is old or new and how your airway is compromised. See an experienced rhinoplasty surgeon for the best results.

Gerald Minniti, MD, FACS · Answer

Hello,I am sorry to hear about your injury.  There are two schools of thought regarding repair of displaced nasal fractures. First I will digress by saying that fracture of the nasal bones is irrelevant unless it is visibly deformed, and then it is obvious and doesn't require an elaborate CT scan to document.One school of thought is to reduce and align the nasal bones early, within the first week.  However, there is a high rate of reoperation in this group, mostly due to persistent defects.  I choose this route if the deformity and/or loss of function is severe and the patient will be ameliorated by doing so.The other school of thought is to wait 3 to 6 months to allow healing and resolution of swelling. This will allow a better idea of the extent of deformity and will allow a better repair.  If you are at the two week mark, then you would still fall into one category or the other depending on the severity of your nasal appearance or function.You should be evaluated regardless so that you can get the best advice possible.  It matters not whether you choose a board certified facial plastic surgeon or general plastic surgeon.  Both have excellent training in this matter.  What matters more is experience. Best of luck!

Kenneth Hughes, MD · Answer

Really these questions need to be answered after an exam.Find a board certified plastic surgeon who has performed hundreds of rhinoplasties.  Look for great reviews and great before 
and after pictures.Kenneth Hughes, MDLos Angeles, CA

Todd C. Miller, MD · Answer

Surgery following trauma to the nose is necessary if you have breathing problems or if you have a cosmetic deformity. If this is the case, it is possible to perform surgery within a couple of weeks of the incident in order to reduce the fracture. If it has been more than a couple of weeks you would likely benefit from waiting 9-12 months to allow the bones to set before reducing the fracture.Often times people experience trauma to the nose and get an X-ray or a CT scan and a non-displaced fracture of the nasal bones is identified. If this is the case, surgery is not necessary. Follow up with and experienced rhinoplasty surgeon who can give you options.

William Portuese, MD · Answer

The decision to perform a reduction of the nasal fracture and operate upon the nose is made if there is a breathing problem, or a significant deviation of the external portion of the nose. To reduce the nasal fracture, medial and lateral osteotomies of the nasal bones are required.  To widen the nasal valves, spreader grafts composed of the patient's nasal or ear cartilage can be performed. Any further deviation of the septum can be addressed at the same time. It is best to try to attempt to repair these sooner rather than later since the nose heals crooked and it will be harder to fix.

Stephen Weber MD, FACS · Answer

Often, nasal fractures can be reduced without surgery during the first week following the injury. Since you're outside that window now would be a good time to seek a consultation with a nasal surgery expert. Most rhinoplasty surgeons will let your nose heal for several months prior to performing rhinoplasty to remedy the damage from your injury. For a primary rhinoplasty, ear cartilage is rarely necessary. Cartilage, if needed, can be obtained from your nasal septum. I hope this information is helpful.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Kimberly Lee, MD · Answer

I'm sorry to hear about your nasal trauma.  It would be best to see a facial plastic surgeon who can evaluate the inside and outside of your nose to ensure that your nasal airflow will not be impaired as you heal.  There are other options than using ear cartilage to repair the nose.  Sometimes just resetting the nose can fix the problem.

Frederic H. Corbin, MD (license restricted) · Answer

Photos and an examination are really needed to give an intelligent response to your question so you should really see a board certified PS in your area

Dr. Corbin

Richard W. Fleming, MD (retired) · Answer

You said you saw a Dr. following nasal trauma two weeks ago - what specialty was this physician? You should see a rhinoplasty specialist to examine you and review the CT scan. Surgery may or may not be necessary but you should be evaluated ASAP; If the appearance or function is different than before the accident correction may be easier at this time.

Hit hard in nose about 2 wks ago from the side. Do I need surgery ASAP to repair or wait? Will it heal without surgery?

Answers (11)

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