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Nasal Fracture/Broken Nose Repair

What is a Broken Nose?

A broken nose refers to external malalignment of the nose, usually related to trauma. It is the most common facial fracture related to the external projection of the nose. A person may experience a fracture in any of the different parts of the nose. The nose is made up of two bones and five cartilages. Most often, the nasal bones are involved in a nasal fracture. This usually presents as a deviation of the top 1/3d of the nose, where the nose appears misaligned. Cartilage fractures are involved in the lower 2/3rds of the nose, and may be less obvious and more difficult to diagnose.

How do you treat a broken nose?

Performing effective broken nose repair depends on the type and severity of the fracture as well as the time elapsed since the injury. There are primarily two methods used to correct a nasal fracture: closed reduction and open reduction. The choice of treatment will be determined by the nature of the fracture, the presence of any structural damage, and the patient’s overall condition.

1. Closed Reduction

Closed reduction is a non-surgical broken nose repair technique used to manually realign the nasal bones back into their natural position. This procedure is typically performed within the first 7 days following the injury, as the bones are still malleable and have not yet begun to fuse together. It is most effective for simple nasal fractures that do not involve significant displacement or complex structural damage.

  • Procedure Overview:
    • The procedure can be done in an office setting or an operating room, depending on the patient’s comfort and the complexity of the fracture.
    • Local or general anesthesia is administered to minimize discomfort.
    • Using external and internal pressure, the surgeon carefully manipulates the nasal bones to reposition them.
    • After realignment, splints or nasal packing may be applied to stabilize the bones and support healing.
  • Indications:
    • Closed reduction is ideal for simple fractures where the nasal bones are displaced but the nasal structure is not severely compromised.
    • It is suitable for patients who seek treatment within 7 days of the injury.
  • Limitations:
    • If more than 7 days have passed since the injury, the bones begin to fuse, making it difficult to realign them manually. In such cases, closed reduction may not be effective.
    • Closed reduction is not recommended for complex fractures, such as those involving significant nasal deformity, severe displacement, or damage to the cartilage and internal nasal structures.

2. Open Reduction

Open reduction is a more invasive broken nose repair procedure used to treat complex nasal fractures, especially when the injury has not been addressed within the first week. This method involves making controlled cuts, known as osteotomies, to “re-break” and realign the nasal bones. Depending on the severity of the fracture, an open rhinoplasty approach may be required to reconstruct and restore the nasal framework.

  • Procedure Overview:
    • Open reduction is often performed in an operating room under general anesthesia to ensure patient comfort and safety.
    • The surgeon makes precise incisions, either internally or externally, to access the nasal bones.
    • Controlled breaks are made in specific areas of the nasal structure to reposition the bones into their natural alignment.
    • For severe fractures involving cartilage damage or significant nasal deformity, an open rhinoplasty approach may be necessary to rebuild and support the nasal framework.
    • Once the bones are repositioned, the surgeon may use splints, grafts, or sutures to stabilize the structure and ensure proper healing.
  • Indications:
    • Open reduction is recommended for patients with complex nasal fractures that cannot be corrected with manual manipulation alone.
    • It is suitable for individuals who seek treatment more than 7 days after the injury or those with severe nasal deformities, cartilage damage, or airway obstruction.
  • Benefits:
    • Open reduction allows for precise correction of nasal fractures, addressing both functional and aesthetic concerns.
    • The procedure can restore the nasal structure and improve breathing, while also enhancing the appearance of the nose.
  • Recovery:
    • Recovery from open reduction may take longer compared to closed reduction due to the more invasive nature of the procedure.
    • Swelling, bruising, and nasal congestion are common but typically subside within a few weeks.
    • Patients are advised to avoid strenuous activities and protect the nose from trauma during the healing period.

Choosing the Right Broken Nose Repair

The decision between closed and open reduction depends on several factors, including the type and timing of the fracture, the extent of nasal deformity, and the patient’s overall health and preferences. A thorough consultation with a qualified facial plastic surgeon or ENT specialist is essential to determine the most appropriate approach for each individual case.

  • For Immediate Fractures (Less than 7 Days): Closed reduction is the preferred option for simple fractures with minimal displacement. Early intervention can effectively realign the bones and prevent long-term complications.
  • For Delayed or Complex Fractures (More than 7 Days): Open reduction is often necessary to correct complex fractures or those with significant structural damage. This approach ensures a precise and stable correction, addressing both cosmetic and functional issues.

Broken nose repair requires a careful assessment of the injury’s nature and timing. Closed reduction offers a quick and effective solution for recent, uncomplicated fractures, while open reduction provides a comprehensive approach for more complex cases. Consulting with an experienced surgeon ensures that you receive the best treatment for your specific condition, leading to optimal functional and aesthetic outcomes.

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Why Is Broken Nose Repair Important?

If a broken nose is left untreated, several complications and long-term issues can arise, affecting both function and appearance. These problems can vary depending on the severity and type of nasal fracture. Here are some common issues that may result from neglect of broken nose repair:

1. Nasal Deformity

  • Crooked or Asymmetrical Nose: An untreated nasal fracture can cause the nose to heal in a misaligned position, leading to a crooked or asymmetrical appearance. This can significantly impact facial harmony and self-confidence.
  • Dorsal Hump or Bump: Improper healing of the nasal bones may create a visible bump or hump on the bridge of the nose, altering its profile and appearance.

2. Breathing Difficulties

  • Nasal Obstruction: A broken nose can lead to a deviated septum or internal swelling that obstructs airflow through one or both nostrils. This can cause chronic nasal congestion, difficulty breathing, and an increased reliance on mouth breathing.
  • Collapsed Nasal Valve: Damage to the nasal structure can result in a weakened or collapsed nasal valve, the narrowest part of the nasal passage. This can further restrict airflow and exacerbate breathing difficulties.

3. Chronic Sinus Problems

  • Recurrent Sinus Infections: A misaligned nasal structure can disrupt normal sinus drainage, leading to the accumulation of mucus and frequent sinus infections (sinusitis). This can cause symptoms like facial pain, pressure, and chronic nasal congestion.
  • Sinus Blockage: Fractures that affect the bones around the sinuses can result in blockages, making it difficult for the sinuses to drain properly. This increases the risk of chronic sinusitis and other sinus-related issues.

4. Persistent Pain and Discomfort

  • Chronic Pain: Unresolved fractures can lead to chronic pain or tenderness in the nasal area, especially when touched or during physical activities. This pain can become a constant source of discomfort and impact quality of life.
  • Headaches: Changes in nasal airflow and sinus pressure can contribute to frequent headaches or facial pain, particularly around the eyes and forehead.

5. Nasal Congestion and Snoring

  • Increased Nasal Congestion: A broken nose that has not been properly realigned can lead to ongoing nasal congestion, making it difficult to breathe through the nose. This can be particularly bothersome during sleep.
  • Snoring and Sleep Apnea: Structural abnormalities caused by an untreated nasal fracture can lead to snoring or even sleep apnea. This occurs when airflow is disrupted, causing the soft tissues in the throat to vibrate or collapse during sleep.

6. Complications from Septal Hematoma

  • Septal Hematoma: A septal hematoma occurs when blood collects between the septum and its surrounding tissue after a nasal injury. If left untreated, it can lead to an infection or cause the septal cartilage to die, resulting in a condition called septal perforation. This can cause persistent nasal congestion, whistling sounds when breathing, and further structural deformities.

7. Emotional and Psychological Impact

  • Self-Consciousness and Reduced Confidence: Visible nasal deformities or chronic breathing issues can lead to self-consciousness and reduced confidence, impacting social interactions and overall well-being.
  • Frustration and Anxiety: Living with unresolved issues from a broken nose, such as pain, breathing difficulties, or aesthetic concerns, can cause frustration and anxiety, affecting mental health.

8. Increased Risk of Future Nasal Injuries

  • Weakened Nasal Structure: An improperly healed nasal fracture may leave the nasal bones and cartilage weakened or unstable. This makes the nose more susceptible to future injuries, even from minor impacts.

Importance of Early Treatment

Seeking timely broken nose repair can help prevent these complications. Early intervention allows for proper realignment of the nasal bones, correction of any structural issues, and a better aesthetic outcome. If you suspect you have a broken nose, it’s essential to consult with a healthcare professional or a facial plastic surgeon to determine the best course of treatment and ensure optimal healing.

Schedule A Consultation With Dr. Mourad

Preparation For A Broken Nose Repair

You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.

Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.

How Is The Recovery From A Broken Nose Repair?

The recovery is not fun at all although it is generally not very painful. Most patients do have obstruction of both sides of the nose that lasts for most of the week or even until you see your doctor. Dr. Mourad provides pain medication if you need it but most of the time Tylenol or no medication is used. You return to our office one week after your procedure and your nose is decongested with any crusts removed from inside of the nose. Most patients are breathing better within a couple of weeks as the swelling inside of the nose improves.

Associated Risks

  • Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
  • Infection: In rare circumstances patients may develop an infection following septoplasty procedures. These are usually managed with intraoperative and postoperative antibiotics.
  • Bleeding: Although rare, patients may have bleeding episodes following nasal surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure. Your surgeon should also go over all medications and supplements that you take to minimizing bleeding risk.
  • Need for secondary and revision surgeries: Depending on the complexity of the surgery, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
  • Scarring and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
  • Local Reactions: Sometimes you may experience local reactions to the ointments, sutures, taping material, and nasal packing used during surgery and postoperatively. This is rarely seen, but may occur. If you have any allergies to certain materials or adhesives you should discuss with your surgeon.
  • Changes in nasal sensation: Patients may experience altered sensations in their nose (pain or numbness). This is exceedingly rare, and if it occurs it is most often temporary.
  • Persistent or Recurrent Nasal Airway Obstruction: Although the goal of surgery is to enhance breathing, sometimes patients may develop persistent or recurrent airway problems. This is rare, but oftentimes is due to poor wound healing or scarring (see above). This may require secondary surgeries to optimize outcomes.
  • Continued need for medical therapies: If you have breathing complaints related to medical causes (e.g. allergies), then you may continue to require medical nasal therapies (e.g. nasal steroids and sprays).
  • Nasal Septal Perforation: A hole in the septum may develop. Oftentimes these do not cause any problems. Other times however, they may cause crusting, bleeding, and breathing difficulties. These require secondary surgeries for repair.

Can I Have Other Procedures With My Broken Nose Repair?

Yes, it’s common to combine a broken nose repair with other functional or cosmetic procedures to address multiple concerns simultaneously and optimize both breathing and aesthetic outcomes. Here are some additional procedures that can be performed alongside a broken nose repair:

1. Turbinate Reduction or Valve Repair:

  • These procedures are aimed at improving airflow and breathing by reducing the size of the turbinates (structures inside the nose that warm and humidify the air) or repairing the nasal valve (the narrowest part of the nasal passage). This can be particularly beneficial if chronic congestion or nasal obstruction is present.

2. Septorhinoplasty

  • Septoplasty is performed to correct a deviated septum, which can cause nasal obstruction and difficulty breathing. This procedure is often combined with a broken nose repair to realign both the external and internal structures of the nose, ensuring optimal functional results.

3. Sinus Surgery or Nasal Polyps Surgery:

  • For patients experiencing chronic sinus issues or recurrent sinus infections, sinus surgery can be done in conjunction with nasal fracture repair. This may involve removing nasal polyps or addressing blocked sinus passages to improve overall sinus function and reduce symptoms.

4. Cosmetic Procedures:

  • If you have aesthetic concerns such as a dorsal hump (bump on the nose) or wish to refine the shape of your nose or other facial features, these can be addressed during the same surgical session. Procedures like rhinoplasty, chin augmentation, or even a facelift can be performed concurrently, allowing for a more comprehensive facial enhancement.

Combining procedures not only saves time and reduces the need for multiple recovery periods but also provides an opportunity to achieve a more harmonious and balanced facial appearance while improving nasal function.

See Patient Before and After Photos

Does Insurance Pay For Broken Nose Repair?

Most insurances will pay for functional broken nose repair, that is, surgery that improves the ability of your nose to work well. Our office will check your benefits for you and let you know what your responsibility will be. We don’t believe in patient surprises and will keep you informed throughout the process. You may have co-pays, deductibles, and co-insurance which we will tell you about. We try to keep our services affordable as we all have financial responsibilities. Of course, cosmetic surgery is never covered by insurance.

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