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Nasal Fracture, Broken Noses in New York

What should you do when you break your nose?

This sounds simple but even some doctors don’t know how a specialist in facial plastic surgery treats broken noses. First, there are only two true emergencies when you break your nose. First and most obvious is a non-stop nosebleed. Obviously, get to the nearest ER or specialist and have them treat your nose, which likely requires topical decongestants and/or nasal packing for a few days.

The other emergency that rarely occurs when you break your nose is called a septal hematoma. The same very delicate blood vessels in the septum that may bleed can also bleed under the “skin” or mucosa of the nasal septum. This causes the septum to blow up like a balloon on both sides of the nose with blood that can’t get out. If this blood isn’t drained (by a specialist), it can cause the septal cartilage to get weak and collapse over a few months time causing a saddle deformity (severely scooped nose). So, if you have trouble breathing after breaking your nose, the inside needs to be checked for a hematoma, preferably within 24 hours.

Now to address the nasal bones: If you do break your nose use ice right away and keep in place, 20 minutes on and 10 minutes off for the first two days. If the only problem is shifting of the nasal bones to the side, they can be repositioned by a minor surgical procedure called a “closed reduction.” Unless you are seen right after trauma, the nose is usually too swollen to do this right away. However, after about two weeks, the bones start to heal so the ideal time is somewhere between three days and two weeks. Beyond two weeks, we may need to wait two months for the bones to fully heal before re-breaking.

If there is a simultaneous deviated septum, cartilage heals differently. I prefer to wait at least six to eight weeks before treating the crooked septum. So, if both a nasal bone fracture and deviated septum are present, I delay fixing the broken nose for the stated minimum of six to eight weeks then re-break it when I fix the septum so the patient only has one operation instead of two (closed reduction then septoplasty).

As for a rhinoplasty after sustaining a broken nose, I prefer waiting at least two to three months to let everything heal and settle if I we are to do more than straighten the nasal bones and a deviated septum.

Treatment for a broken nose can be a simple surgical procedure. But if not treated properly, the consequences can be more severe.

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