Nasal fractures, or broken nose, is one of the most common injuries to the face. Unfortunately, everyday incidents like falling off a bike, taking a hit during sports, or bumping into a door can displace your nasal bones or septum. The entire nose may be moved over to one side. Sometimes, just the central portion of the nose is disrupted, resulting in a “C” shaped deformity. This is usually soon accompanied by swelling and bruising.
The Closed Reduction Procedure
The options for repairing a broken nose vary based on timing after the initial injury. The bones may be reduced or ‘set’ into their previous position by a qualified physician within a few hours after the injury before significant swelling begins to distort the assessment of the nose. Since no incisions are used during this procedure, it is called a ‘closed reduction,’ (in contrast to an open reduction which is done at a later time and is generally more invasive). The septum can also be set if needed, however this component usually requires additional procedures if significant disruption has taken place. The other reason to see a medical professional as soon as possible is to rule out a septal hematoma, or blood collection within the septum, that could potentially result in nasal infection and deformity if not addressed in a timely manner.
Timing of Repair
If a closed reduction does not take place immediately, it is generally better to wait about 5 -7 days until swelling has subsided in order to adequately assess the nose before resetting the bones and septum. Once more than 10 days have passed however, the bones have begun to be set in place and a closed reduction may no longer be possible. Once too much time has elapsed, patients generally must wait at least 6 weeks following the injury to address the fractured bones and septum with an ‘open reduction’ or ‘septorhinoplasty.’
Open Reduction and Septorhinoplasty/Reconstructive Rhinoplasty
Once an older fracture has healed into place, resulting in an external deformity and sometimes nasal breathing compromise, an ‘open reduction’ of the nasal bone fractures or ‘reconstructive rhinoplasty’ is necessary to correct these issues. The soonest that these procedures can take place is 6 weeks after the injury, allowing time for the bones to adequately heal in place and tolerate the necessary manipulations. While a closed reduction is usually completed in the office with adult patients, open reduction and reconstructive rhinoplasty are performed in the operating room under general anesthesia. During open reduction, the nasal bones are re-fractured in a controlled fashion with ‘osteotomies’ to return them to the pre-injury position. Oftentimes, adjusting the nasal bones alone is not sufficient to adequately correct the functional and cosmetic deficits. During a septorhinoplasty or reconstructive rhinoplasty, the nasal septum is adjusted and cartilage grafts are carefully harvested from the septum to create grafts used for structural support and enhanced cosmesis. During rhinoplasty (in contrast to septorhinoplasty) the focus is on the cosmetic appearance of the nose rather than functional breathing improvement. Following surgery, you will have a cast on your nose for about one week. This cast will support and protect the healing nasal bones from accidental trauma or movement. Except in infrequent cases of significant bleeding, packing will not be placed in the nose. You should expect to feel congested for a few days. During the first week, activity is limited in order to minimize bruising or bleeding.
