I think I broke my nose!

 

Patients often ask me, “What do I do if I think I’ve broken my nose?” 

Well the first thing to do is to look and see if it appears deformed. If the nose is fractured, and there is a deformity (like it is moved to one side or the other), then it will need to be repaired. But if the fracture does not lead to a deformity, usually it just can be watched. Sometimes, patients will have already been seen in the ER and an x-ray or CT scan reveals a fracture. Even if a fracture is seen on a scan, if it doesn’t lead to a deformity then likely it won’t need a surgical repair.

Let’s say that there is a deformity.

Ideally, it will need to be repaired in less than two weeks. If we wait too long then the bones will “set,” and a simple procedure, called a closed reduction, will not be able to be performed because the bones will not be able to be moved back to their original position.  So if you think you’ve broken your nose and there is an obvious deformity, then you need to be seen quickly so that surgery can be performed quickly.  

So what’s a closed reduction?

It is a very simple procedure where I will loosen up any impacted bones with a tool called an elevator, then I will actually just push the bones back to where they’re supposed to be. It may seem brutal, but I just use my thumbs and push on the side of the nose to bring it to the midline.  Usually patients are under anesthesia for this, but it can be done without anesthesia or sedation and done with just topical and local anesthetics. Most patients prefer to be asleep!

So what can you expect after surgery?

You usually will have a cast on your nose for 4 to 7 days. There may be a little bit of swelling, but there should not be any more pain than when you first broke it in the first place.

What about expectations for return to normal appearance?

Research has shown that 90% of patients are satisfied with their appearance after a closed reduction. I found in my own experience that it is only around 2 to 3% of patients who actually desire a revision surgery.  

Can any other problems result from a nasal fracture?

Yes. Some patients can have nasal obstruction, where they have trouble breathing through their nose after the trauma. However, this does not need to be repaired quickly and often times I will treat nasal obstruction conservatively, especially if patients do not have need to go for a closed reduction in the short term.  

 

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Teach & Learn, NoseErin Shellenbergernasal, fracture, broken nose, trauma