Email a Friend
Print Article
You Broke Your Nose - Now, What Do You Do?
A broken nose, or nasal fracture, is the most common facial injury. This is because the nose is the most prominent facial feature. In addition, the nasal bones are the thinnest in the body and, therefore, they are more subject to being broken.
Naturally, the key to proper treatment is to make the correct diagnosis. The following are signs and symptoms of a nasal fracture. All or some may be present.
You need to be examined if any of these features are present after an injury.
Only one feature of a broken nose represents an emergency. If there has been an injury to the internal nasal septum (the internal vertical partition that separates the left and right nasal passages, and there has developed a septal hematoma. A septal hematoma is blood accumulating under the covering of the cartilage and exerting pressure on the internal tissues. If not relieved, this collection of blood can cause destruction of the cartilage and even a partial collapse of the nose. The hallmark of a septal hematoma is that after the injury, the patient has nearly complete blockage of the nose and hardly any nasal breathing. It does require an examination by either an emergency room doctor or a specialist in facial surgery or plastic surgery. The septal hematoma which is not necessarily painful, can be dealt with quickly and the serious problems averted.
With respect to the typical management of the broken nose, an examination by a specialist is important and it should not be delayed. The risk of delay is that if a proper diagnosis is not made, then the mal-aligned broken fragments may begin to heal in their abnormal position. Typically, the window for examination and initial treatment is up to ten days. After ten days, the parts begin to weld together, where they are, and it is difficult to manipulate them back into the normal anatomic position.
The doctor will examine the inside of the nose to see if there is any fracture or injury to the nasal septum which could be causing airway obstruction. Obviously, he will look to see if that septal hematoma has developed.
The external examination of the nose is conducted to see if there has been a shift or fragmentation of the nasal bones and the cartilages attached to it. The doctor will be feeling for asymmetries and irregularities. Often, within the first hour or so, not much swelling has taken place. But typically, within 24 hours, swelling and bruising have presented themselves and maximize by 48 to 72 hours. If none of the serious issues such as septal hematoma are present, he will recommend being re-evaluated when the swelling has gone down such that the more accurate diagnosis can be made by look and feel. Typically, that time line is five to seven days after injury. Plans should be made, at that point, so that if there is to be a near-term correction, it can be done within the ten-day, first window of opportunity.
Let's assume that for whatever reason, the patient either doesn't have the nasal fracture recognized or procrastinates with respect to receiving treatment within the first ten days. If that is the case, the nose is going to have to go untreated and, therefore, maintain possibly both abnormal shape and inadequate breathing for at least two months. At that point the tissues have healed - welded together - and they can be operated upon. Prior to that, the fragments may be "egg-shell"-like and difficult to work with.
Therefore, in summary, the first window for treatment is within ten days. There is a period of no treatment for the next seven weeks or so and then at the two-month mark or thereafter, definitive treatment can take place.
-Robert Kotler, MD, FACS
Naturally, the key to proper treatment is to make the correct diagnosis. The following are signs and symptoms of a nasal fracture. All or some may be present.
- Swelling of the nose.
- Tenderness; soreness to touch.
- Bruising, particularly around the eyes.
- Nosebleed.
- Change in shape.
- Change in breathing.
You need to be examined if any of these features are present after an injury.
Only one feature of a broken nose represents an emergency. If there has been an injury to the internal nasal septum (the internal vertical partition that separates the left and right nasal passages, and there has developed a septal hematoma. A septal hematoma is blood accumulating under the covering of the cartilage and exerting pressure on the internal tissues. If not relieved, this collection of blood can cause destruction of the cartilage and even a partial collapse of the nose. The hallmark of a septal hematoma is that after the injury, the patient has nearly complete blockage of the nose and hardly any nasal breathing. It does require an examination by either an emergency room doctor or a specialist in facial surgery or plastic surgery. The septal hematoma which is not necessarily painful, can be dealt with quickly and the serious problems averted.
With respect to the typical management of the broken nose, an examination by a specialist is important and it should not be delayed. The risk of delay is that if a proper diagnosis is not made, then the mal-aligned broken fragments may begin to heal in their abnormal position. Typically, the window for examination and initial treatment is up to ten days. After ten days, the parts begin to weld together, where they are, and it is difficult to manipulate them back into the normal anatomic position.
The doctor will examine the inside of the nose to see if there is any fracture or injury to the nasal septum which could be causing airway obstruction. Obviously, he will look to see if that septal hematoma has developed.
The external examination of the nose is conducted to see if there has been a shift or fragmentation of the nasal bones and the cartilages attached to it. The doctor will be feeling for asymmetries and irregularities. Often, within the first hour or so, not much swelling has taken place. But typically, within 24 hours, swelling and bruising have presented themselves and maximize by 48 to 72 hours. If none of the serious issues such as septal hematoma are present, he will recommend being re-evaluated when the swelling has gone down such that the more accurate diagnosis can be made by look and feel. Typically, that time line is five to seven days after injury. Plans should be made, at that point, so that if there is to be a near-term correction, it can be done within the ten-day, first window of opportunity.
Let's assume that for whatever reason, the patient either doesn't have the nasal fracture recognized or procrastinates with respect to receiving treatment within the first ten days. If that is the case, the nose is going to have to go untreated and, therefore, maintain possibly both abnormal shape and inadequate breathing for at least two months. At that point the tissues have healed - welded together - and they can be operated upon. Prior to that, the fragments may be "egg-shell"-like and difficult to work with.
Therefore, in summary, the first window for treatment is within ten days. There is a period of no treatment for the next seven weeks or so and then at the two-month mark or thereafter, definitive treatment can take place.
-Robert Kotler, MD, FACS
Labels: cosmetic surgery, nose job, rhinoplasty
2 Comments:
Hey, that's me! :)
I'm glad you could use my image. :)
Post a Comment