Rhinoplasty Forum and Chat

Support Forum, Chat, and Message Board for Patient's Questions and Answers Broken Nose (Nasal Fractures) 2

Explore what others have to say about a Broken Nose and Plastic Surgery with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

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Rhinoplasty Nasal Surgery Important Information

Question: Re: nose injured/ 2 yr old

My 2 yr old daughter was running and fell face first against the bottom of the end table. She banged her nose quite severely. Her nose did not bleed but it did swell on the right side with the area under her right eye appeared slightly black and blue. After approximatly 2 weeks we noticed a pronounced bumb on the side of her nose. We just returned from taking her to the pediatrician. The doctor claims that a 2 year old cannot break her nose because it is only made up of soft cartiledge. The bone does not form until the age of 5 or 6. I'm concerned because I have a deviated septum as a result of a broken nose. Should we push to see an ENT specialist? I feel the pediatrician is fluffing the matter off. Is there anything that can be done for an injured nose on such a young patient anyway? Isn't time of the essence when it comes to manipulating the cartiledge back into place? Please let us know more as I'm not finding alot of information on the internet about young children's nose injuries on the internet. Thanks in advance.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Nasal fractures do happen in children, they are just not as common. Yes most support structures are made of cartilage in the very young. Although cartilage is more flexible, it can still tear, pull from its attachments, and crack. Injured cartilage can bend over time. With greater energy injuries, nasal fractures and facial fractures can also happen. If cartilage has become dislocated (out of place) it should be put back in place as soon as possible.

I am a plastic surgeon. It is a plastic surgeon's website about facial fractures you are learning from. I take care of facial fractures. Why ask me if you should see an ENT? You need to see a specialist who handles facial fractures. That can be either an ENT or a plastic surgeon who handles nasal trauma. In some communities it is one, in other communities it is the other. In Richmond both ENT and Plastic Surgeons offer nasal trauma care. Some are more experienced than others. I have cared for nasal trauma for years. My commitment to patient education about nasal fractures is unique from my prior searches on the Internet. Such commitment to education is how I try to care for all of my patients.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Nasal Fracture

Dr Bermant,

I broke my nose while sledding on Thursday. I went to see a specialist today and he suggested (non-invasive) surgery where he uses a blunt object to set my nose in place. I would also be required to wear a cast and have packing.

I am going to get a second opinion, as the Doctor did not have a very good bed-side manner and did not want to spend alot of time explaining the procedure and possible alternatives with me.

It did not hurt when I broke my nose and I have had very little swelling and no bruising. In fact, no one would ever guess from looking at me that my nose is broken. (I did have X-rays to be sure. It did bleed when it happened) I cannot see that my nose is bent or otherwise deformed in any way.

The doctor told me that one side caved in slightly and that is why I needed it to be set. I am wondering from the little bit of information that you have. Can you tell me the possible long-term affects I may suffer if I do not get the surgery.

And, if I do go ahead with it, Is it really necessary to have a cast and packing?

I would appreciate any information you may give me. The doctor wants to do the surgery on Friday, next week.

Thank You,
A

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

No the little information that can be learned from an email message does not replace an examination and evaluation. I do not like to use packing unless the fracture really needs it for support or bleeding needs control. I almost always use external splints (plastic casts). Uncorrected nasal deformity can result in nasal airway obstruction, interference of odors reaching the sensors in the nose, and deformity. (Please see other posts on my website.)

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: injured nose

The other day I was playing basketball and was slapped in the nose. I didn't hurt and I didn't bleed. It has been a couple of days and I still have a little bump on my nose. Will this swelling go down? I don't think I broke it because it's just a little swollen(you can hardly tell). It's mildly sore right now, but I'm worried about the bump going away. If you have a second, I would greatly appreciate some info.
Thank you

J

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Email examination and diagnosis is not yet available. I cannot make a diagnosis and recommendation without an examination and evaluation. If you have a question about your nose, may I suggest you see someone who can examine you in person and render an opinion.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: nasal fracture

Dear Dr. Bermant:

In February i was assaulted by two individuals although my thick scull alowed me to avert any serious damage they did manage to fracture the left lateral wall of my nose, compressing the bone into the septum. Brace yourself because hears where the long story begins. I visited the emergency room when i noticed the difference between the two sides of my nose, they told me there was no fracture, however the next day the radiologist called me back and informed me there was indeed a fracture. Five days after the initial incident i visited an ear nose and throte specialist who had permenently repaired my brothers cronically bleeding nose. The fracture being obvious he didn't bother to look at the X-rays he told me i had a choice to have a closed reduction awake in the office or asleep in the hospital. Egar to heel I opted for to have it done right away, so he shot me up with novicane and atempted to pull the bone back in position. It didn't take long before he decided that he would have to put me under. Heres where the story gets interesting (to me at least): as far as i was informed the operation simply involved manipulating the bone back into place. I took the cast off as recomended 3 days later, and it wasn't long before i discovered a large crack running up the left side of my nose and slightly over the bridge about a third of the way. I asked him about it and he responded that there may be certain features i could feel but not see, feeling confident because of my brothers experience with this doctor i accepted his answer. he put me on an oral quarterzone to bring the swelling down, but three weeks later there was little if any improvement and the bone had obviously recollapsed, he then informed me that i would need an opened reduction with a septoplasty. For my intire adult life i had a bump on the bridge of my nose that i had always thought to be caused by an injury when i was younger. The doctor offered to remove the bump free of charge during the procedure. I jumped at the chance but i made sure that he told me exactly how and what he was going to do. He told me that he would shave the bump down gradualy so that i would have a streight profile elevate the bone back into position and streighten my warped septum. I was informed that it would be 3 to 4 weeks four my breathing to come back, and that the bone would be as strong as ever in about a month. Two days after the surgery the right side packing was removed it bled profusely and quickly swelled completely shut to the point that swallowing made my ears pop under the extream presure. Six days after the surgery he removed the left packing suprisingly the left side which was origanally broken cleared quite quickly in a few days while the right side was coming along a little slower. One week later the left was as clear as ever but the doctor used long q tipes to break up scar tissue he repeated this one week later (after it took that whole week to bring both sides back to where they were) and the left hasn't been clear since. The right side is on and off but is clear most of the time, but it is rare for the left.

It is now one month and 12 days since the procedure the left is still I'ld say 90% blocked, and the bone certainly hasn't healed. I'm truely begining to have doubts about my doctor it seems that everything he has told me has not come true. The doctor himself displayed a great deal of confidence that my breathing would return 100% so much so that he said it may be even better then before the incident (which suprised me because i never had trouble breathing before) I am abled to move my nasal bone frome side to side and even press the brige down when i asked the doctor about it he said it has only been a month (when he had prior told me that it would be as strong as ever at this point). I can't help but wonder why the left side would be so clear so soon after the operation and now a month and a half later almost completely blocked. I've also discovered another crack on the right side of the bridge, not to mention that it is not nearly as semetrical as it was. For the most part the bump is gone but between the bridge and tip of my nose ther is a large indentation be it more felt than seen i can't help but wonder if everything is cosher. He now wants to give me an in office procedure to corterize the left side of my nose and I've been put back on the anti-inflamitory medication. I am even wondering weather or not a septumplasty was really neccessary as my doctor never looked at the X-rays (to my knowledge). I'm truely concerned that i may be a victom of malpractice or simple neglegence. Please tell me if my situation sounds normal to you and what i should do if it doesn't.

Please email me your response, weather or not you post this on your web site. I thank you very much for the time you've taken to read this. I would also like to express my admiration, you are obviously a patient oriented doctor, and i can only hope other doctors are as cocerned as you seem to be. Once again thanks.

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Nasal fracture non unions - where the bones fail to heal together are possible but very rare. No something does not sound right, however without an examination and evaluation I cannot comment further.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Nasal injury

Hi. I am a professor at ... University (Psychologist), and I have been searching the Web for information that will help me to make an important surgical decision. I was hoping you might be able to help me by giving me relevant information. I of course realize that without seeing me in person, you cannot render any definitive diagnosis, but I am in search of as much information as I can gather for the purposes of making an informed decision that is in my best interest.

3 years ago, I had a Septo-Rhinoplasty. I was thrilled with the results. About 1.5 years ago, I had a car accident, and the left side of my nose served as a punching bag for the air bag that deployed on impact. I returned to the surgeon who had originally done my surgery for assistance. At first, everything seemed okay. He pulled my septum back into place in the office, as it had been dislodged by the airbag trauma. Afterwards, he ordered X-Rays of my nasal and facial bones. They came back indicating no breaks in the nasal bone. He sent me on my way...

About 2 months later, a small lump formed along the left side of my nose, and there also seemed to be an indentation forming where the nasal bone meets the cartilage on that side. I returned to my surgeon, who told me that sometimes, following trauma, it takes a short while for these types of problems to show themselves. He told me that the Periostium (spelling?) that covers the nasal bone was probably injured in some way in the accident (perhaps detatched from the bone), and often when this happens, it acts as though there is no bone remaining -- that is, it begins to make its own bone to attach to, hence the lump. At the time, he attributed the indentation that had formed to a loss of cartilage. So he began to place shots in the lump, hoping that it would break up the newly formed mass and encourage the periostium to return to the nasal bone. This continued for 9 months. It didn't work. So my surgeon told me that it could be fixed via a surgical procedure. He also wanted to take a fascia graft from my scalp because he said that my skin was thin around the nasal bone. I was given the impression that the surgery would return things back to their prior state, with little if any, complications. When my surgeon opened my nose up to perform the surgery, he found that in fact, there had been breakage after all...but it was the type that would not have shown up on an X-Ray. The length of the nasal bone itself was in tact, but the trauma of the airbag seemed to have shifted the nasal bone such that it caused the bone to detach from its 2 connecting points (at the skull, and at the cartilage). He found many specules of bone laying around everywhere. So he told me that he took some of them out, but had to try to replace as many as possible, and then covered it over with the fascia. He also had to suture the bone back to the covering layer. In spite of this unexpected set of circumstances, I was assured that everything would be fine, and things would return to normal.

For the first month following the surgery (which I had only 5 months ago), everything seemed to be fine. However, about a month ago, problems began to arise. The left side of my nose began to look somewhat protruded (swelling effect), and the indentation where the bone meets the cartilage was apparent again. My surgeon began to place shots in my nose again in an effort to reduce the lumping, which he said was typical. He also told me that the indentation existed because the bone had to be sutured back to the periostium, and therefore was somewhat behind it. The indentation represented a kind of "empty space" between them. The only way to remedy this problem, I was told (short of grafting bone from my hip), would be to inject Dermis into the area to camoflage the lost bone and give the appearance of continuity.

Well...things continued to get worse. Over the past month, the swelling on the left side of the nose has worsened. A prominent lump has formed on the upper portion of the left side of my nose, and it is very painful (and unsightly). I was placed on antibiotics for a week (Cipro), and I was told by my surgeon that if the antibiotics do not work, surgery will be required to remove the lump. The explanation I was given for the formation of the extensive inflammation was that the periostium can become highly inflammed following trauma..and this is what had happened in my case. Needless to say, I was rather upset by the events that had transpired, and I was surprised that I was now perhaps facing another surgery only 5 months after the last procedure, which was supposed to correct the damage of the accident. The worst part is, my surgeon told me that the surgery may not be the full answer to this problem, as the inflammation could return again in the future following the procedure. I do not want to make anymore decisions regarding further surgery until I am convinced that I have all of the available data, including alternatives and potential consequences. I trust my surgeon, and I have confidence in his abilities, but I also feel that given the circumstances, I need to take a more critical stance before I proceed. Do you have any information you could offer for me to help me further my investigation and decision process? Is the circumstance I have described rare? Common? Are there other options available for people in my situation? I realize that you probably do not want to give extensive medical advice over the internet, but I am really becoming distressed about my condition, and I would greatly appreciate anything you could tell me that might be of help to me.

Thanks In Advance,
D

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Your course of events as described are not typical and I do not understand what your doctor was doing (per your note). Nasal structures can be weakened by some types of rhinoplasty, but usually this is not a factor of the operation. Nasal fractures are best diagnosed clinically, Xrays sometimes work but especially in cases of injury between cartilage and bone, nothing often is seen on the radiograph. Fracture nonunions are very rare and can be a real problem to treat. Repeated steroid injections can have a number of possible complications. An infection in the bones of the nose is the rarest of the complications you mention and can be very destructive in nature. Infections of other tissues of the nose can be a problem also. The extent of possible options and risks are best undertaken by a doctor taking care of you. Some rhinoplasty surgeons do a great deal of work with nasal trauma. Others restrict their practice to one more cosmetic in nature. In my practice I do both and feel very uncomfortable with the descriptions you relate but this could be a misunderstanding of what really transpired and is lacking the important information that an in office consultation would provide. If the information your doctor is helping you with is not enough, you might consider telling this to him/her. If you still want more information try asking your doctor to help you get a second opinion.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: broken nose

hi doc,
my name is b. im on a surf trip in indoneasea. well i was surfing the other day and i fell on my surfboard and boke my nose really good. well i was on a boat trip and 7 hours to the nearest hospital, so i set it myself. it looks good compared to what it did look like. well my question is this.. how long do i need to wait until i can surf again? should i go back to the states to seek a professional opinion? how easy will it be to rebreak it? im supposed to stay in indo for another 6 weeks.. should i?
thanks for your time and quick response,
surfer out of water

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are many things that can be wrong with a nose that has been broken. If there is a septal hematoma or a number of other issues, then being seen by a competent physician is always the best. However severe problems after nasal fracture are not very common. The fractured nose is not stable after fracture and healing is usually necessary before it can take much abuse. Immediate reduction of a fracture is always better than delayed. Secondary surgery is possible in most cases. No matter how hard I look at my computer screen, I cannot examine your nose. There is no way I can make a clinical recommendation in this scenario.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Question: Re: Re: Nasal injury

Dr. Bermant:

First, I would like to express to you my sincerest gratitude for the time you took out of your busy schedule to offer me your insights and your thoughts regarding my somewhat bizarre set of circumstances. I received your note after having another surgical procedure, which at this time, seems to be healing well, although time will surely tell what the true prognosis will be.

The condition I reported to you did not improve with antibiotics. When I returned to my doctor following a week on Cipro, he told me that I needed to have surgery as soon as possible. He admitted that he was not certain what the source of the progressive lumping was, but spent an hour with me, providing information about what he believed to be the possibilities (with the help of a series of questions I brought along with me). One possibility he gave me was that it was something surgical that could be cut out (periostial thickening?); another possibility that he gave me was that it was fluid build up of some kind that resulted from an infection and could be drained from the inside; yet another possibility was that it was some form of autoimmune disorder, such as lupus (he doubted this was the case, but felt it necessary to mention anyway). Needless to say, I was somewhat concerned about the possibilities, but went ahead with the surgery on his advice. I suppose many people would argue that a second opinion would have been warranted in this case, but I trusted the circumstances and the surgeon, and decided to follow his advice.

I had the surgery 3 and a half weeks ago. It turned out that the painful lump was caused by a build-up of fluid -- a fluid filled sac that had formed in the area between the periostium and the bone. Apparently, this was caused by an infection. My doctor's best explanation for why the infection developed (and hence the fluid build-up) was that he treated the area too aggressively following the surgery in December. That is, he began to place cortisone shots in there almost immediately after the surgery (to control swelling and thickening), along with shots of Dermis to fill in irregularities and indentations in the bone that I found aesthetically displeasing (which became apparent after pieces of broken bone were removed from the December surgery when he sutured the detatched bone back to the periostium). Anyhow, it appears that all of these shots of various compositions resulted in an infection, and caused fluid to build up in that area. So, in this most recent surgery, my doctor drained the fluid from the inside, cut out all of the Dermis he had injected in various places, and covered over the left side of my nose with a cartilage graft from my septum. The purpose of this most recent graft was to take care of the aesthetic problem caused by the bone irregularity now that some of it was lost as a result of the car accident and the December surgery done to re-attach the severed components. He also cut some of the periostium away (though not all of it), because it had thickened somewhat, and he said that in my case, it has this tendency to start "building bone" and cause lumping.

When my cast was removed 4 days after the surgery, everything looked great (but was obviously swollen). The left side of my nose looked smooth and no irregularities or indentations were apparent. My doctor said, however, that he was not pleased with the degree of redness in the area where the problem was before, so he put me on Cipro again for 10 days. I was told that the redness indicated the presence of some residual bacteria which could cause a re-infection. I was also told that remaining fluid was still draining inside the nose, but I had to watch it closely because there was a chance that the fluid could re-accumulate while the nose was healing (after the 3 week healing time when the bone and periostium adhere, any remaining fluid could get 'trapped'). If re-accumulation of any kind seemed to be occurring, I was told to contact my doctor so that he could drain it manually.

For the first 3 weeks, everything was flat and smooth. About 1 week after I finished the Cipro, I began to notice a slight raising in the "problem" area. so I contacted my doctor, and he drained it in the office with a needle (OUCH!). He said that there was no pus in the fluid he drained, and only a bit of blood came out (which he showed me). He then checked it again 2 days later and said that I did not need to have it drained again at this time. I was told however, that I must continue to watch it because there is a chance it might reaccumulate and if this occurs, I have to have it drained again. He did assure me, however, that this process should not go on indefinitely.

At this point, everything seems to be healing appropriately. From an aesthetic perspective, the left side looks good...smooth, no indentations, no visible irregularities. It does still look at bit 'swollen', but I suppose that at this point, it should. My doctor did tell me that at some point, he will have to put those cortisone shots in again to prevent thickening from occurring. He doesn't want to do it yet, because he said that I seem to respond differently than most people, and my nose is highly sensitive and gets infected easily from too aggressive interventions of this nature.

I am happy at this point that the ordeal seems to be over, and I am pleased that aesthetically speaking, things seem to look good. I am however, still somewhat concerned about the future...in the past, things looks good for awhile, but began to reveal problems months down the road (4 months or so post-op). My doctor assured me that structurally speaking, I should not be concerned that the left side of my nose is at a grave disadvantage (I had asked if it was signficantly weaker and more vulnerable to being hit, etc...because of all of the interventions that had occurred, removal of bone, cutting a portion of the periostium, etc.). My biggest fear is that down the road, my nose is going to collapse. I am feeling somewhat apprehensive about doing "normal" things at this point, because I guess I am still not totally convinced that the left side of my nose is structurally sound. Perhaps with time, I will come to realize that it is healing well, and become less apprehensive. It does throb from time to time, but I assumed that this was because it has only been a month since my surgery, and especially after getting a drainage needle in my nose, things are pretty sore.

I want you to know how much I appreciated your commentary. My condition was becoming more and more distressing, and I was afraid that my nose was going to fall apart in the process!! I also appreciated your frankness with regard to your concerns about the details of my condition as I relayed them to you. I must admit, it frightened me a bit, but I also realize that you are getting information from me second hand, without ever actually examining my nose yourself. Perhaps I was somewhat naive in following my doctor's advice without getting a second opinion, but the first surgery I had with him was so successful (although purely cosmetic in nature, as your alluded to), and he has a wonderful reputation for his work. I realize that this does not mean that he cannot make mistakes, but I do hope that this time, I am on the road to recovery. If anything goes wrong this time, another opinion will be sought out without hesitation.

Does this most recent procedure and explanation seem reasonable to you, given what I told you before? Do you think that at this point, even though things appear to be healing well, I need a second opinion? Is my concern about structural weakness and future difficulty unwarranted?

Thank You Again for Everything,
D

Dr. Bermant responds:

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

I am glad things seem to be working out. From a distance I cannot make the types of recommendations you are requesting. It is difficult to predict what will happen with healing tissues and a doctor who has examined you has a better chance of giving you better information than one who has not.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

rhinoplasty support forum and message board with questions and answers

Rhinoplasty Nasal Surgery

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