Blunt trauma to the face can cause a variety of injuries, though a nasal fracture (broken nose) is among the most common. Whether it is an elbow during a basketball or soccer game, a fall off your bike, or an unexpected encounter with a car door, the result is the same: the nose bones and septum are displaced. Often, there is an obvious and immediate shift in the shape of the nose, with the nose pointing to one side. In some cases, the middle portion of the nose is moved independently, and a “C”-shaped deformity occurs. Within a few hours, the soft tissue covering of the nose becomes quite swollen and bruised.
The timing for repair of a broken nose is frequently debated. If you are able to see a qualified medical provider immediately (within a few hours), it is possible that the nose can be “set” before the bones and cartilage heal in their new, crooked position. This treatment is called a closed reduction, since no incisions are made. If the septum has been injured as well, this may be manipulated at the same time. However, the septum will frequently require further intervention if it is significantly damaged. Lastly, it is important to rule out a septal hematoma (collection of blood in the septum), as this can lead to permanent damage and possible collapse of the nose.
If you do not have an immediate closed reduction, it is best to wait some time for swelling to decrease before attempting to “set” the nose. This delayed reduction is best undertaken at five to seven days after the injury. In some cases, the nasal bones may already be fixed (stuck in place) at this time, and a more extensive operation would be required to straighten the nose. Regardless of the timing, closed reduction requires placement of an external splint on the nose. This is generally worn for a week or so and is meant to stabilize the bony pyramid as well as protect against secondary injury.
For patients who have an older fracture that has completely healed with an obvious deformity, or for those who have developed functional problems such as nasal obstruction or snoring, a functional or reconstructive rhinoplasty is indicated for repair. Rhinoplasty is the surgical modification of the structure and function of the nose, also known as “nose job surgery” or nose reshaping. In trauma cases, this has to do with either or both the external shape of the nose or the anatomy inside the nose. Narrowing of the nasal passages caused by a fractured septum, scar tissue, or cartilage damage can cause persistent blockage of airflow that is not responsive to medications. During a reconstructive rhinoplasty, it is often necessary to open the nose and repair the cartilage, as well as reshape the nasal bones with controlled fractures called osteotomies.
Soft tissue injuries may occur from blunt or penetrating trauma to the nose, with or without fractures of the nasal bones or septum. These injuries should be thoroughly cleaned and then repaired immediately for the best cosmetic result. Fine gauge sutures and two-layer closure technique are used in most cases to carefully align the injured skin. Even with an excellent repair, visible signs of the trauma may persist. This may require secondary treatments, including topical therapies, steroid injections, laser resurfacing, or formal scar revision. For most surgical and traumatic wounds, a scar preparation containing silicone is recommended to improve the appearance of injured area and reduce the risk of hypertrophic scar or keloid formation. Damage to deeper structures, such as the tip cartilages, may require more specialized care and reconstructive rhinoplasty.
Patients with a history of a broken nose may be a candidate for reconstructive rhinoplasty or other procedures. Dr. Ransom will assess your nasal injuries, structure, and function during your consultation, and is happy to discuss the details of all types of nasal surgery at that time.
Frequently Asked Questions
This will depend on exactly what is done, and is related to the type and severity of your injuries. In most cases, you will have a cast on the nose for about a week after the procedure. This helps to protect the nose from accidental trauma, and also stabilizes the bones during the initial healing phase. No packing is used in the nose, except in rare cases where there has been significant nasal bleeding. Your nose may feel congested for a few days, but this resolves relatively quickly. You should limit your activities following repair and concentrate on recovery.
In most cases, your insurance will cover treatment for injuries to the nose. However, older fractures that have healed generally require submission of documentation to your insurance company. Coverage is not guaranteed, and benefits are determined according to the specifics of your policy. Dr. Ransom is in-network with most major PPO plans as well as Medicare. We are happy to look into your benefits following your consultation.