Nasal Fracture (Broken Nose) Repair Virginia
The nasal bones are amongst some of the weakest bones in the body. The nasal cartilages at the bottom 2/3rd of the nose are like spring boards or car bumpers to prevent fractures with minor trauma. More severe trauma can break or dislocate the nasal cartilages as well as the nasal bones.
After a nose trauma the most important step is to make sure other facial bones are not affected such as the cheek and eye socket (orbital) bones. Its also crucial to be examined to make sure there is no hematoma inside the nose – septal hematoma. Blood collection inside the lining of the septum – septal hematoma – can cause necrosis and death of the septum and nasal collapse or septal perforations (hole in septum). Immediate diagnosis and evacuation of septal hematoma is necessary to prevent this devastating complication of a nasal fracture or trauma.
While CT scans and X-rays are good for diagnosis of other facial bone fractures, the diagnosis of a nasal fracture is a “clinical diagnosis” requiring physical examination and thorough history taking by the Emergency Room doctor.
The nose should be evaluated by a Plastic Surgeon after a few days when the swelling has gone down. Emergency room physicians are usually the initial examining doctors. If a Closed Nasal Reduction is needed to reset the nose back, this should be done between 5 to 12 days after the initial trauma. Not too soon so that swelling obscures the contour of the nose and not too late so that the nose ha completely set! The other option is for Open Nasal Reduction with osteotomies to rebreak the nasal bones in a more favorable fashion and reduce the nasal fracture. This can be done at any time although doing this after 5 days but prior to a month makes the most sense. The final treatment is a full Septo-Rhinoplasty to reconstruct the nose. This should be done after 3 months from the initial trauma so most of the swelling is gone. A complete septo-rhinoplasty done too early will not have precise results and should be delayed to at least 3 months after the trauma. Most often insurance will not pay for a complete septo-rhinoplasty while many insurances do pay for Closed Nasal Reduction and/or Open Nasal Reduction. If the nose is extremely damages then the procedure may need to be staged with an initial closed or open nasal reduction to improve the nose as best as possible and then a complete septo-rhinoplasty later on to improve on the initial fracture reduction.
Nasal fractures in young children are especially problematic as the nose and septum are important in growth of the mid-face and damage to the growth centers can have adverse effects. This is why plastic surgeons advise on avoiding major septoplasty on children younger than 14 years of age.