November 29, 2015
Nose is one of the most commonly fractured bone of the body. However this fact usually doesn’t strike one as surprising, with the placement of nose and its projection right from the center of your face.
A nasal fracture not only affects your bone but it also alters your cartilage as well. There would be a prominent alteration in the appearance of your nose and as a consequence your entire facial structure. If not treated properly, broken noses can lead to functional and cosmetic problems which tend to be long term. However, before moving on to the treatment and surgery of nasal fractures, let us first delineate what a nasal fracture actually is and what it implies.
What is a Nasal Fracture?
Let us have a look at the anatomy of our nose first of all. The bridge of our nose comprises of two pieces of bones conjugated with a piece of cartilage. This long piece of cartilage is what gives your nose its particular shape. When this bony part of your nose gets broken, we say that a nasal fracture has taken place. Many factors could be responsible for bringing on this nose trauma such as car accidents, fist fights or other injuries etc.
What are the Symptoms of a Nasal Fracture?
A broken nose or a nasal fracture is usually accompanied with few or all of the symptoms listed below.
- You may encounter swelling on the bridge and external end of your nose.
- Your nose might get crooked.
- You may have to face internal or/and external bleeding from your nose.
- At times, nasal fracture might also be accompanied with bruising around the eyes.
- You might face difficulty breathing.
These symptoms are indicative of a nasal fracture, but the doctors would usually recommend you to have a CT scan or an X-ray done to determine whether or not you have a nasal fracture.
This is because a severe fracture might get noticed easily since there is greater deformity and a greater nose bleed. However, mild fracture might tend to go unnoticed since the nosebleed is brief and the swelling is also minimal.
When is the right time to see the doctor?
If you get struck on the nose, it is important that you consult your physician immediately to determine whether or not you have a septal hematoma. In case you do have a septal hematoma, then immediate measures ought to be taken to treat it promptly so that your nose’s condition doesn’t worsen.
However, if you are suffering from a nasal fracture, then the best line of action to take would be to consult an otolaryngologist i.e. a head and neck surgeon. If you go see the surgeon after a week or two of your injury, then there are good chances that your nose would be fixed immediately.
However, if you do not act promptly, then it might take months before your surgeon deems it appropriate for your nose to be straightened surgically and then fixed.
Immediate Treatment for Nasal Fractures
Immediate treatment for nasal fracture mainly comprises of controlling its apparent symptoms which include nose bleeds and ensuing pain. It is only possible for the actual treatment to begin once the swelling has subsided sufficiently since only then can one make an adequate assessment of the extent of damage caused to your nose. If damage caused isn’t severe, then a skilled doctor might realign the cartilage/bone without undergoing an extensive surgery. Splints, as well as nasal taping might be deployed in this process.
Surgical treatment becomes mandatory if your nasal fracture is a complicated one. Surgery would be required to realign the broken bone and cartilage back into its place. The surgery’s process varies from patient to patient and might deploy local or general anesthesia depending upon the individual requirements of the case.
Given below are two major types of surgical procedures concerning nasal fractures.
- Open Reduction
- Close Reduction
Closed reduction is comparatively a simpler process. Its results and outcomes are deemed to be pretty acceptable.
Open Reduction, on the other hand, purports to produce better cosmetic results. It is also possible that after the CR has been done, the patient might get an additional OR done for an enhanced cosmetic appearance.
Yet, ultimately it is the surgeon’s discretion who has to decide whether Open Reduction would work best for a particular patient or Close Reduction since ORs don’t work equally well for all patients, neither do CRs.
- Close Reduction Technique
Close Reduction is an important surgical technique for Nasal Fractures. In this process, the patient’s nasal bones are manipulated, however, no incisions are made. This method has been deployed for a very long time for treating fractured noses. It's functional results are quite credible, however, the same cannot be said for its cosmetic outcome.
- Open Reduction Technique
Open Reduction generally involves a number of surgical procedures with the inclusion of septoplasty, osteotomies, and septorhinoplasty. This technique is considered to be the most appropriate one, particularly in those cases where there are strong chances of patients needing a revision surgery.
What happens during the surgery?
- The doctor would either make use of local anesthesia or general one.
- A doctor, a nurse, an anesthesiologist and a surgical technician are present inside the operating room.
- There is continuous monitoring of oxygen saturation and cardiac rhythm during the entire procedure.
- The surgery may last from one to several hours depending upon the method deployed and the complexity of the fracture.
What happens after the surgery?
- The patient ought to take bed rest with his/her head elevated.
- Elevation of head helps to subside edema.
- The patient should avoid straining himself during this recovery period. In case of constipation, a laxative should be used.
- Swelling and bruising are normal after effects of nasal fracture surgery and would subside after 7 to 10 days.
- The surgeon would probably place a nasal splint or cast over your nose, which is usually removed after one week following the surgery.
- Bleeding is normal and would decrease gradually. The mustache/ gauze dressing would collect this blood. Once it gets saturated, it ought to be changed.
Dr. Amjadi MD, DDS, FACS
Certified by the American Board of Plastic Surgeons
915 Gessner Rd #870
Houston, TX 77024
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