A Broken Nose – Broken Nose Surgery

broken-nose

Broken nose symptoms

  • Bruises around the eyes and/or a slightly crooked nose following injury usually indicate a fractured nose
  • If the bones are pushed over or out to one side, immediate medical attention is ideal, but once soft tissue swelling distorts the nose, waiting 48-72 hours for a doctor’s appointment may actually help the doctor in evaluating your injury as the swelling recedes – apply ice while waiting to see the doctor
  • What’s most important is whether the nasal bones have been displaced, rather than just fractured or broken – imaging with an x-ray or CT scan may help confirm a displaced nasal fracture
broken-nose-CT-scan

CT scan showing a displaced nasal fracture

 Broken nose surgery

  • For noticeably displaced bones, surgeons often attempt to return the nasal bones to a straighter position under local or general anesthesia
  • This is usually done within seven to ten days after injury, so that the bones don’t heal in a displaced position
  • Because so many fractures are irregular and won’t “pop” back into place, the procedure is successful only half the time
  • Displacement due to injury often results in compromised breathing so corrective nasal surgery, typically rhinoplasty surgery, may then be needed
  • Rhinoplasty surgery is typically done on an outpatient basis, and patients usually plan to avoid appearing in public for about a week due to swelling and bruising

Broken nose causes

  • A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose — often the bone over the bridge of your nose
  • Common causes of a broken nose include contact sports, fighting, falls and motor vehicle accidents that result in trauma
  • Signs and symptoms of a broken nose include pain, swelling and bruising around your nose and under your eyes – your nose may look crooked, and you may find it difficult to breathe
  • Treatment for a broken nose may include procedures to realign your nose

Symptoms of a broken nose

  • Signs and symptoms of a broken nose may appear immediately or may take up to three days to develop
  • Signs and symptoms may include:
    • Pain or tenderness, especially when touching your nose
    • Swelling of your nose and surrounding areas
    • Bleeding
    • Bruising around your nose or eyes
    • Crooked or misshapen nose
    • Difficulty breathing through your nose
    • Discharge of mucus from your nose (rhinorrhoea)
    • Feeling that your nasal passages are blocked

Causes of a broken nose

  • As the nose is the most prominent feature on your face — protruding unprotected— it’s also the facial feature most at risk of injury
  • Broken noses account for approximately 40% of all facial fractures
  • Your nose is supported by cartilage (in the front) and bone (on the back and bridge) – when this framework of bone and cartilage is struck with a force, the bones can crack or fracture — resulting in a broken nose
  • Common causes of a broken nose include:
    • Injury from contact sports, such as football, basketball or soccer
    • Fighting, when punches are thrown
    • Motor vehicle accidents
    • Falls
    • A broken nose can even be caused by activities such as walking into a fixed object or by rough, wrestling-type play

Complications of a broken nose – other broken nose symptoms

Deviated septum

  • A nose fracture may cause a deviated septum, a condition that occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced to one side, narrowing your nasal passage on that side
  • Medications can help you manage a deviated septum, though surgery is required to correct the condition

Collection of blood (nasal septal haematoma)

  • Sometimes, a collection of blood called a septal hematoma may accompany a nose fracture
  • A septal hematoma can block one or both nostrils
  • Septal hematoma requires emergency surgical drainage to prevent cartilage damage

Cartilage fracture

  • If your fracture is due to a forceful blow, such as from an automobile accident, you may also experience a cartilage fracture
  • If your injury is severe enough to warrant surgical treatment, the surgery would address both your bone and cartilage injuries

Neck injury

  • Likewise, nose fractures resulting from high-velocity injuries — like those experienced in motor vehicle accidents — may be accompanied by injuries to your neck (cervical spine)
  • If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck
  • If you suspect a neck injury, see your doctor immediately

When to see an ENT doctor

Seek emergency medical attention if you experience a nose injury accompanied by a head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness

  • Difficulty breathing
  • Bleeding you can’t stop
  • A noticeable change in the shape of your nose that isn’t related to swelling, such as a crooked or twisted appearance
  • Clear fluid draining from your nose

What you can do before your appointment

  • Immediately after your injury, apply ice to the area to help keep swelling down
  • Use light pressure to keep the ice on your nose
  • Over-the-counter pain relievers, such as paracetamol, can help reduce pain. Ibuprofen can also help relieve inflammation

Your appointment

  • If you’re injury is severe, you’ll need to seek immediate medical attention and won’t have time to prepare for your appointment
  • But, if the injury to your nose is minor — accompanied only by swelling and moderate pain — you may choose to wait before seeing your doctor
  • This allows time for the swelling to subside, so you and your doctor can better evaluate your injury
  • However, it’s best not to wait longer than a week before seeing your doctor if your signs and symptoms persist – during this waiting period, get medical attention if:
    • The pain or swelling doesn’t progressively get better — and eventually disappears
    • Your nose looks misshapen or crooked after the swelling recedes
    • You can’t breathe efficiently through your nose even after the swelling subsides
    • You experience frequent, recurring nosebleeds
    • You have a fever
  • You’ll probably start by seeing your family doctor or general practitioner – however your doctor will likely refer you to an ENT specialist (Otolaryngologist)
  • If your nose is broken and requires repair this surgery is done as an outpatient procedure
  • You will need to have the repair done within two to three weeks for best results

Surgical repair of a broken nose

Fixing displacements and breaks your doctor may use several approaches:

Closed reduction – broken nose surgery

  •  If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them with a nonsurgical procedure called closed reduction
  • For best results closed reduction should be conducted no more than 14 days after the fracture
  • During this procedure, your doctor uses a nasal speculum to open your nostrils
  • Special instruments are used to help realign your broken bones and cartilage and return them to their original positions.
  • Surgery for broken nose pain relief – you will need pain medications, including local injections and nasal sprays, before the procedure
  • Broken nose surgery recovery – if you experience persistent bleeding related to any nasal fracture, you may need to have your nostrils packed with moistened gauze strips – these strips will contain an antibiotic ointment to help prevent infection

Surgery – rhinoplasty or septorhinoplasty

  • Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may not be candidates for closed reduction
  • In these cases, surgery to realign the bones and reshape your nose (rhinoplasty) may be necessary
  • If the break has damaged your nasal septum, causing a deviated septum with resulting obstruction or difficulty breathing, then reconstructive surgery called septorhinoplasty (rhinoplasty and deviated septum surgery) may be recommended
  • Both surgeries are typically performed on an outpatient basis
  • Many people choose to stay home for a few days during the recovery process since considerable swelling and bruising are common side effects
  • Discomfort, swelling and bruising usually improve significantly after around one week

Click here for more information about septoplasty surgery

Click here for more information about rhinoplasty surgery

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