Usually the patient hears a crack, followed by some bleeding. There may be an immediate external deformity, though not always. If there is significant displacement of the nasal bones or nasal septum then breathing may be blocked on one or both sides. Over the next several hours black eyes (periorbital ecchymosis) may appear and the nose will usually start to swell both on the outside and inside.
Trauma that causes a nasal fracture may also cause a fracture of the bones around the nose including the eye socket, the jaw, and the roof of the inside of the nose, known as the skull base. If the bones of the eye socket are fractured (an orbital floor fracture or “Blowout” fracture) you may have double vision, especially when looking up, and your cheek may be numb on the same side. If the bones of the upper jaw (maxilla) are fractured then your teeth might not fit together like they did before the trauma. Rarely in cases of severe trauma the thin bone separating the very top of the nasal cavity from the brain may crack and some spinal fluid may drip into the nose. This looks like water, and may taste a little salty.
How are nasal fractures evaluated?
Many people will go to the ER when they suffer significant nasal trauma and usually the doctor will order a CT scan which will reveal any fractures around the nose, eyes, and jaws. If the fractures are limited to the nose then typically they will have you follow up with an ENT doctor in a few days. If they noted that some blood collected in your sinuses, or if you have a cut on the outside of your nose they may give you some antbiotics.
When you come to see us in a few days we will perform an examination to be sure that you don’t have a blood clot between the internal membranes of the nose (known as a septal hematoma). We will painlessly pass a telescope into the nose to get a clear idea of where the fractures actually are. We will take good photographs to document the injury and the subsequent treatment result.
We will also check for double vision (diplopia), misaligned teeth (malocclusion), cheek numbness and a spinal fluid (cerebrospinal fluid also known as CSF) leak. If you have any of these we will discuss treatment options for these as well as for the broken nose.
What is the treatment for a broken nose?
There are several ways to treat a broken nose and this is a special interest of Dr. Staffel, who wrote his thesis on optimizing treament of nasal fractures.
By the time you arrive at our office you will most likely have some swelling which can obscure the actual shape and position of the underlying bones. It is quite helpful bring a pre-fracture photograph so we can tell what your nose looked like before it got broken.
Nasal fractures do not always require treatment. If there is no septal hematoma, the deformity is slight, and breathing remains adequate then there will not be any long-term medical complications and if the patient does not desire treatment then no treatment is necessary.
If there is a deformity or difficulty breathing then we recommend correction during the second week after the fracture. This allows some time for the initial swelling to resolve making evaluation on the operating table more accurate. Correction is typically performed under general anesthesia at the Shea clinic ambulatory surgery center. Once you are asleep we replace the nose into its pre-fracture position. We may also straighten the internal wall of the nose (septoplasty) if it is crooked.
After the second week the bones become “sticky”. We can still push them back into their original position but they tend to shift back toward the fractured deformity. For this reason if we do not perform the surgery within 2 weeks of the fracture we recommend waiting for 1 year until the bones have completely healed and then they can be refractured in a controlled manner in the operating room and placed into position.
Occasionally it’s difficult to tell whether there will be a significant deformity within the first 2 weeks after the fracture either because the swelling has not resolved or deformity is more minor. In these cases there is no harm in waiting to see if the deformity is disfiguring, and if so then correction at one year is recommended.
What is recovery like after broken nose repair?
Recovery from the surgery feels like having a cold for a week. The internal swelling makes you feel a stuffy and so it can be a bit hard to sleep. Although we usually provide pain medication, many patients require nothing more than ibuprofen (Motrin®, Advil®) or Tylenol. We advise most people to take a week off of work, many find they can perform paperwork after two or three days.
You will have a cast on the outside of your nose for 5-7 days. You may have some slight bruising around your eyes. Occasionally will use internal splints made of soft silicone. These may make you feel a bit stuffy, like having a cold. We remove them after 5-7 days and this is not painful. Splint Removal Video We do not use “packing” as this is painful to remove and not necessary. We may advise using contact lenses or taping glasses up for a few weeks after removal of the cast to keep any pressure off your nasal bones. You may return to work or school in a week and often even earlier. Somewhat surprisingly the pain after correction of a nasal fracture is usually relatively minor.
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