Surgery Needed for Broken Nose and Slight Deviated Septum?

Question

I broke my nose 5 days ago from an accident at home. I went to see a plastic surgeon today in NYC, found an MD on the net. I was told that I have a broken nose, and it's fractured with slight deviated septum. My nose is crooked a bit, but I can breathe fine. I just leave my noise alone. I am over 45 years old. Would I need to have a closed Rhinoplasty or Septoplasty?

Matthew Richardson, MD · Answer

If the nose is crooked after a nasal injury, it can often be corrected with a closed nasal bone reduction procedure if performed within the first 10-14 days after the injury. In some cases, this procedure is not enough to correct the deformity (particularly if there is significant septal cartilage injury), and a formal septorhinoplasty surgery might be needed to straighten the nose.
If nasal breathing is not an issue after an injury, and patients are not worried about a crooked nose, then there is no reason to perform surgery at all. Keep in mind though, that a closed nasal reduction is a quick and easy procedure whereas a full septorhinoplasty is much more involved, and that the first 10-14 days after an injury are the critical time window to determine what might be needed for correction.
Be sure to see a rhinoplasty expert.
All the best,

Evan Ransom, MD, FACS · Answer

Thank you for the question. If you have a mild deviation of the nose and/or septum, this can often be corrected in the first few days after the injury via a closed reduction. This procedure is done with topical numbing medications in many cases. If the fracture is "set" (not mobile), then a more involved septorhinoplasty would be needed. If you do not have any significant breathing problems, the decision to have this done would have more to do with cosmesis. Best of luck moving forward!

Jeffrey E. Schreiber, MD, FACS · Answer

If you're nose is broken and you're breathing okay, you don't have to get surgery! However, if your nose is crooked and you want it straightened, your surgery may involve putting the bones back to where they were (relatively simple with no incisions needed sometimes.) If you nose is very crooked, then you may require bone or cartilage grafts to help make your nose have a straight look. This is more involved and is usually done with an open approach. Good luck!

Richard W. Westreich, MD · Answer

Generally speaking, nasal fractures can be repaired at 2 time points.
The first is a procedure called a closed reduction, where no cuts are made and the bones are just pushed back into place. Generally, it is recommended to do this procedure within the first 7-10 days. I have done it as late as 3-4 weeks in severely deviated noses. This is often done with some light anesthesia to make it comfortable. Sometimes the septum will move over with the bones. Often it will not.
The second is a procedure more like a rhinoplasty, where the bones are rebroken and set in the middle. This is usually done after 3 months of healing has occurred. This definitely requires anesthesia.
Although some surgeons will try to do a septoplasty soon after an injury, I prefer to wait until the inflammation is gone. This allows more precise correction of the cartilage, in my opinion. Therefore, I tell patients they should wait 3 months to get their septum fixed.
For cases like yours, I generally recommend to have a closed reduction and then wait 3 months. If the breathing problems are still present, then a septoplasty can be done. Most patients feel better and don't need the second surgery for breathing.
Good luck

Eric M. Joseph, MD · Answer

If your nose looks crooked after the trauma, but you're breathing fine, you should have this repaired. In general, you can have your nasal bones repositioned without "re-breaking" them within 10 days of your injury.
You can have a "closed reduction" of your nasal fracture performed with local anesthetic in the office, with minimal discomfort, and no downtime. If you wait longer than 2 weeks, you'll need a more extensive surgery with general anesthetic.
Since you're breathing fine, I don't think you need a septoplasty.
I hope this helps, and best regards.

Shahram Salemy, MD, FACS · Answer

As long as you are breathing ok and are not concerned about the appearance you can wait.  In general, I like to reset a broken nose within 2 weeks after the injury-- after that, the bones start to heal in place making it more difficult to correct.  After 2 weeks, if you decide you do want something done, I would wait a few months for all of the internal scarring to settle down and to be able to get a good idea of the final result- at this point, if you do not like the way things look, then you could have a closed rhinoplasty to improve the breathing and to improve the look.
Good luck,
Dr. S

Otto Joseph Placik, MD · Answer

You can chose to do nothing if the appearance or breathing is acceptable to you.
If you decide on surgery, closed reduction is usually the procedure of choice for a mild rhino-septoplasty

Jacqueline Wegge, MD · Answer

If your nose is noticeably crooked after the trauma, now is actually the time to intervene.  In the first two weeks after the trauma before the nose heals, the bones will still be mobile, and it is usually possible to re-align them with a simple closed reduction.  This can generally be done in the office with local anesthesia, or in the operating room with some sedation based on your comfort level.  The procedure involves using an instrument in the nose and pressure to "pop" the bones back into their correct location, and then usually requires wearing a splint afterwards for protection while the bones are healing.  It is a simple procedure that can potentially save you from needing or wanting a more invasive surgery in the future.

Michael M. Omidi, MD, FACS · Answer

A broken nose can cause block the airway.  This can be the result of the broken bone or
septum compromising the airway.  An
examination and possibly a CT scan can determine the extent of the fracture and
deviation.  From there your surgeon can
suggest a plan which can include surgery. 
If your airway is not compromised then you can decide if you want a
procedure to correct the external appearance of the fracture or deviation of
the nose.  Insurance often pays for the
procedure if there is significant airway restriction.  Often a cosmetic rhinoplasty can be
performed at the same time.  Insurance
would not cover that portion so you would be responsible for that part of the
procedure.  Recover is generally 6 weeks
and after an assessment you your surgeon. 
 Best
of luck. Dr. Michael Omidi

An in-person exam with a
board-certified plastic surgeon is the best way to assess your needs and
provide true medical advice.

Garrett H. Bennett, MD · Answer

Many times a broken nose can be moved back to its initial shape in the office under local anesthesia. The bones can be straightened and a further surgery prevented. If you can't tolerate this then you can have the repair with a higher level of anesthesia. Many emergency rooms and even some doctors will tell you to wait several weeks before getting an evaluation. This is wrong. If you wait then the bones will knit and you will need a formal rhinoplasty after 2 months. You will only need a septoplasty if the deviated nasal septum is causing difficulty with breathing. If you have trouble breathing you will want to see someone who is also trained in otolaryngology as a general plastic surgeon has limited training inside the nose. Again, don't wait more than 2 weeks to have an acute nasal fracture repaired.