Nasal Fractures
The Problem
The nose contains the most frequently broken bones in the face. A "broken
nose" may have injured bone, cartilage, nerves, skin or mucosa
(nasal lining). The nasal bones rigidly support the upper portion of
the nose between the eyes. The cartilages are flexible supports that
maintain the shape of the rest of the nose. The septum divides the nostrils.
The support of the septum is made of both cartilage and bone. The septum
is held near the lips by the nasal spine a part of the maxilla (the
bone under the upper lip).
Nasal Bones and Cartilages 
Air traveling through the nose is normally controlled by the position
of the cartilages. Bone and cartilages out of place can obstruct the
nose. Swelling and clotted blood will also limit the flow of air.
The nose humidifies the air before passing into the lungs. When the
nose is blocked air travels through the mouth. Prolonged breathing through
the mouth will leave it dry. The injuries may be as simple as just some
bruising or may result in severe deformity.
Bruising results from blood spreading into the skin and the underlying
tissues. The bruises often migrate around the eyes and eventually down
the cheeks. The body slowly absorbs this pigmentation. These bruises
will usually fade over time.
Swelling comes from injured tissue and can result in pain. Moving fractured
bones and cartilage results in additional swelling. The weight of glasses
or goggles can further injure a broken nose.
This
X ray shows a broken nasal bone. Although such a text can be helpful,
clinical examination in experienced hands may be more valuable. Fractures
that are not displaced do not need reduction. Without the radiographs
however the patient will not know if nasal protection will be needed.
A nasal fracture may be a part of a more severe injury. There may be
other bones injured in the face. The nasal fracture often is treated
at the same time as the more severe facial fractures. More severe forms
of nasal fractures may need surgery where the bones are realigned and
held in place with tiny wires, plates or screws. There may be other
parts of your body that have been injured that usually take priority
over the nasal fracture.
Benefits from Surgery
An injured nose can bleed from lacerations (cuts) of the skin or inside
the nose. These cuts may need to be repaired and evaluated immediately.
Excessive activity may restart bleeding. Blood can also collect inside
tissue (hematoma). A septal hematoma can cause trouble by injuring or
thickening the septal structures. Injured septal structures may result
in the loss of structural support of the nose. Septal thickening may
obstruct the nose. Someone should look into your nose to determine if
there is a hematoma.
Cartilage or bone may be broken, out of place, or injured. To restore
your appearance these may need realignment. Many individuals have prior
injuries, distortions, or asymmetries that have gone unnoticed. We ask
that you bring a preinjury photograph to help see what your nose was
like before injury. A fracture reduction will not improve old deformities.
Even if the nose is made symmetrical it will drift back into the preinjury
position. After the structures have healed a rhinoplasty (surgery on
the nose) may help correct deformities.
Alternative Care
The choice is either no evaluation or evaluation, treatment or no treatment.
You could let an injured nose just heal as it is. Deformities would
not be corrected and problems that might be improved would not be not
addressed.
How it is done
Sometimes the nasal structures go back into place with a minimum of
force. Often a reduction with manipulation and instruments are necessary.
A combination of medication inside the nose and injections around the
nose lessens the discomfort. If there are other injuries you may need
a more extensive evaluation and treatment. Many simple fractures can
be reduced in a well equipped office or outpatient setting. More complicated
injuries may need hospitalization and services of anesthesiologists
and other medical personnel.
This reduction should take place within a certain period of time from
the injury. Unless the injury is severe, Dr. Bermant has his patients wait a couple
of days after my early evaluation (until most of the swelling goes down).
If we wait too long the operation becomes more difficult and has a lower
chance of success. Your doctor should help you determine if an operation
is necessary, and the best timing. Do not delay in making your appointment.
A young patient with a nasal fracture
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 |
Bones out of place, some bruising, and minimal swelling |
Nasal splints for the patient and friend after closed reduction |
Reduced nasal fractures can move out of alignment.
A plastic splint molded to your nose will help maintain alignment. Additional
deforming forces like glasses or goggles can defeat the splint and must
be avoided. Nasal packing may rarely be necessary for internal support
or control of bleeding. Since such packing is usually uncomfortable,
I avoid this technique unless absolutely necessary.
Risks
Breaks in bone or cartilage may heal with a deformity. Even if well
aligned, a bump can develop. Cartilage is an unusual material. Small
cracks develop when severely bent (which can happen with trauma). As
the cartilage heals, it can distort. After waiting several months for
healing, Dr. Bermant may use this unusual property to correct these
bends. By surgically scratching the cartilage Dr. Bermant will try to
make it bend the other way. Cartilage may need to be removed or reinforced
surgically. The surgical correction of the septum is called a septoplasty.
Infection is rare, but if it occurs it can cause significant problems.
Lacerations cause scars. External scars sometimes need surgical revision.
Internal nasal scars and deformities can increase your chance of nose
bleeds. Damage to nerves can result in altered, diminished, or painful
sensation or poor muscle function (paralysis). Injuries may obstruct
the small holes that drain your sinuses. Pressure in sinuses can result
in painful headaches.
What Happens After Surgery
Restoring the nasal anatomy may cause new swelling and bruising. The
medication used to numb your nose wears off after several hours. If
you required more extensive anesthesia or sedation, these take longer
to wear off. Unless you do things that increase swelling or pain (like
hit your nose), after nasal reduction generally it is not very painful.
Bending and vigorous activities may increase your discomfort. Returning
to work is a function of what you do, the degree of your injuries, and
your own response to injury.
Other
Bulletin boards
More on nasal obstruction septoplasty
Rhinoplasty Bulletin Boards
PlasticArt
Tour of Nasal Deformity in Art
Nasal deformity, is it
bothering you?
Nasal hump and drooping tip deformity
Deformity after nasal fracture
Nasal tip loss
Nasal
Fracture (broken nose)
