Nasal FractureNasal Fracture (broken nose)

Learn about nasal fractures and broken noses. Then explore rhinoplasty, nasal surgery, & sculpture of the nose by Dr. Michael Bermant, MD plastic & cosmetic surgery.

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

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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 broken nose or nasal fracture

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.

xray fracture nasal tipThis 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

Nasal fracture child closed reduction nasal fracture

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.

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This page last updated on: April 21, 2012

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