Broken nose. How long do I need to wait before having surgery?

Question

Hello, I broke my nose playing softball one week ago. I immediately went to the ER where they told me they could not put it back into place until the swelling went down. On Monday the ENT told me it was "too late" to fix it. The diagnostic: The left wing of the nasal bone is fractured; an 8 mm fragment is slightly rotated, with 1.5 mm step off. The posterior nasal septum is also fractured with about 2 mm step off. They gave me an appt. for Oct, 20. Do I have to wait a month to have surgery?

Jeffrey G. Lind II, MD · Answer

Thanks for your question.  In my practice, for a similar patient, I would try to get the surgical correction performed for their nose within the first couple of weeks after breaking it.  If you wait longer than this it will be much more difficult to move and set the nasal bones.  If you aren't able to get the surgery within a couple of weeks of the injury then I would wait for a few months.  If there is a cosmetic deformity (or functional problem) at that time, your nasal bones can be re-broken (osteotomy) and the bones can be set in the appropriate place.  You should see a plastic surgeon with experience in this area.  Best of luck to you.

John Michael Thomassen, MD · Answer

After nasal trauma, within the first 1-2 weeks it is possible to reposition a fractured nasal bone and possibly septum.  However, if too much time has passed the fractures have healed out of place and it is not possible to reduce without a formal rhinoplasty. However, at this stage, it is best to wait until the fracture has completely healed and then rasp the bone if there are residual irregularities and do a septoplasty.

Mark A. Brzezienski, MS, MD, FACS · Answer

If you are a week out from a nasal fracture...this is a good time.  The fracture can still be moved into the correct position and splinted.  The farther you get from the initial fracture, the more healed the fracture will be.  As about a month approaches...particularly in a young person...it's difficulty to move.In patients who show up late...I tend to wait about 6 months from the initial injury. But at that point, there is no rush.

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

I am sorry that you are having concerns about your procedure
and thanks for sharing your question. I can appreciate your
concern.
After a fracture you can try to reduce the fracture
immediately while the swelling is not too significant. 
If you are very swollen then you have 2 weeks to have the
job done. Otherwise the bones will start repearing and the repositioning will
be more difficult.
If your time frame is longer than 2 weeks, then wait for 6
months before doing the big surgery for re-breaking and redoing your nose.
Finally, make sure that you have a
consultation with a board certified plastic surgeon that specializes in after
weight loss surgery.

Wishing you the best in your journey

Wayne F. Larrabee, MD · Answer

The nature and timing of a repair depends on the fracture itself. It is important initially to be examined to see if there is a septal hematoma (collection of blood) which may need immediate treatment.It sounds like you didn't have that. If the nasal bones are deviated they can be repositioned without major surgery for the first week or so after the trauma.  After that they may require osteotomies (bone cuts) to be moved back. If the septum is involved as in your situation results have been shown to be better with an operation to fix the problem rather than just a reduction. If it is decided to wait and there is any significant bony problem  we usually wait 3 months at least to be sure the bones are stable enough to be repositioned.

Robert S. Schmidt, MD · Answer

Thanks for your question. Sorry to hear about your injury! The best time to fix a broken nose is within a two week window following the injury. Usually we wait a week initially to allow time for swelling to go down, then determine if a nasal fracture needs to be reduced. If so, we try to do it during the second week because the bones are still pretty mobile. This can be done in the clinic under local anesthesia if you choose. After the bones have started to heal and won't move, then I advise waiting about six weeks for the fracture to completely heal, then rebreaking the nose if needed. I hope this helps! Good luck!

William Marshall Guy, MD · Answer

Hello m.l.e.t,Sorry to hear about your nasal break.  With regards to timing if the injury is recent ( as in within a few days) then the nose can be "set" without a larger surgery.  Depending on someone's pain threshold this can be done in the clinic but more commonly it is done in an operating room.  Once about two weeks have passed the bones have healed enough in their current position that simply trying to push them back into place will not work.  In this case, it can be better to wait a few months to allow for the swelling to go down before doing a formal nose surgery (rhinoplasty).  Many surgeons even prefer the latter option initially because it allows for a more precise placement of the damaged tissues.  I would recommend you consult with a facial plastic surgeon to go over your surgical options.  The sooner you see him or her the better as the appropriate planning can be made.  I hope this helps and good luck.

William Portuese, MD · Answer

It is important to go be examined by a nasal  specialist such as a double board-certified ENT/ facial plastic surgeon to evaluate the internal and external portion of the nose. A broken and twisted nose can be repaired at any time after the injury. A closed reduction can usually be performed in the first week, but after that period of time, osteotomies of the nasal bones will need  to be performed, also known as an open reduction nasal fracture.  Both procedures are performed with all of the incisions placed on the inside of the nose. For more information, many examples of broken nose repair in our practice, please see the link and the video below

Broken nose. How long do I need to wait before having surgery?

Answers (8)

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