Broken nose - setting and treatment
A broken nose is the most common injury to the facial skeleton, affecting both athletes and victims of traffic accidents or unfortunate domestic incidents. Due to the nose's central position, any change in its structure affects not only facial aesthetics but primarily the body's respiratory function. A key element of post-injury therapy is professional nasal reduction, which allows for the restoration of the original anatomy and patency of the nasal passages. Early medical intervention is essential, because neglecting the symptoms can lead to permanent deformities and chronic sinus problems.
Injury diagnosis and diagnostics versus nasal reduction
Accurate diagnosis of a nasal bone fracture is primarily based on physical examination and a history regarding the mechanism of injury. Patients usually report severe pain, swelling, nosebleed (epistaxis), and a characteristic "crunching" sensation upon touch, known as bone crepitus (crepitus). An ENT specialist or a plastic surgeon assesses the symmetry of the nasal pyramid and the patency of both passages, checking for the formation of a nasal septal hematoma. The presence of a hematoma is an emergency condition, requiring immediate incision and drainage to prevent cartilage necrosis.
While diagnosis is often made clinically, medical imaging serves a supportive and documentation role prior to the procedure of nasal reduction. A lateral X-ray (RTG) remains the standard; however, in cases of suspected comminuted fractures or associated maxillofacial injuries, the physician may order a computed tomography (CT) (TK). Imaging allows precise determination of the direction of bone fragment displacement, which facilitates planning for subsequent reduction. It is important to remember that increasing swelling can mask the deformity; therefore, the examination should be performed as soon as possible after the event.
When is surgical reduction of the nose necessary?
The decision to perform surgical repositioning of the nose is usually made upon finding a visible deformity or impaired nasal patency. If the fracture is non-displaced, the doctor may decide on conservative treatment, consisting of taking anti-swelling medication and limiting physical activity. However, when the nose's alignment has become crooked or one of the nasal pyramid's walls has collapsed, nasal repositioning becomes the only method to prevent permanent deformities. The optimal time to perform the procedure is between the 3rd and 7th day after the injury, when the swelling begins to subside, and the tissues have not yet undergone initial consolidation.
Preparing the patient for bone repositioning
Before undergoing a procedure such as resetting the nose, the patient must be evaluated by an anesthesiologist, especially if the procedure is to be performed under general anesthesia. Basic blood tests are required, including coagulation parameters (INR, APTT), to minimize the risk of excessive intraoperative bleeding. The patient should remain fasted for at least 6 hours before the procedure, and also inform the doctor about all medications being taken, especially those affecting blood viscosity. Proper mental and physical preparation significantly enhances patient comfort during and after the intervention.
How is a nose setting procedure performed step by step?
Nasal bone repositioning, or the popular nose setting, can be performed using a closed or open method. In the closed method, the surgeon does not make external incisions, but instead uses specialized tools, such as a Boies elevator or Walsh forceps, to lift and move the bone fragments into their proper place. The procedure typically lasts 15 to 30 minutes and is performed under local or general anesthesia, depending on the complexity of the injury and the patient's preferences. The key to success is restoring the symmetry of the nasal bridge line and ensuring that the nasal septum does not block airflow.
After manually setting the bones, their stabilization is necessary to prevent re-displacement. The following are then used:
- Anterior tamponade, which is the insertion of gauze strips or hemostatic sponges into the nasal passages, acting as an internal scaffolding.
- External nasal splinting - application of a plaster, thermoplastic, or aluminum splint to the nasal dorsum, which protects the nose from accidental injuries.
- Topical medications - application of antibiotic ointments to prevent infections in the mucous membrane.
In rarer cases, when closed nasal reduction does not yield the desired effect, or when the injury is old and malunion has occurred, open plastic surgery (rhinoseptoplasty) may be necessary. During this procedure, the surgeon makes incisions inside the nose or on the columella, which allows for full visualization of the bony and cartilaginous structure. This type of surgery is significantly more invasive and requires a longer recovery time, which is why it is so important to consult a specialist immediately after the injury.
Postoperative treatment and convalescence in nose setting
The recovery process after a procedure such as nose repositioning usually lasts several weeks, with the first few days after the surgery being the most crucial. The nasal packing is usually removed after 24-48 hours, which brings the patient immense relief and restores the ability to breathe through the nose. The external splint (cast) remains in place for about 7 to 10 days, protecting the delicate bones during the initial ossification process. During this time, the patient should avoid sleeping on their stomach, bending over, and wearing glasses that rest on the bridge of the nose, as this could undo the nose repositioning.
During healing, it is common to experience bruising around the eyes (the "raccoon eyes" symptom) and soft tissue swelling. These are temporary symptoms that can be alleviated with cold compresses and the use of recommended vasoconstrictor drops. The patient must also refrain from blowing their nose for the first 2 weeks, as a change in pressure in the nasal cavity can cause displacement of the repositioned bone fragments. Regular follow-up appointments allow the surgeon to monitor whether the nasal reduction has resulted in a lasting functional and aesthetic effect.
Post-procedure stabilization and care
Proper hygiene after a procedure such as nasal reduction involves gentle rinsing of the nasal passages with a sea salt solution, which prevents the formation of scabs and facilitates the healing of the mucous membrane. Tobacco smoke and polluted air should be avoided, as they can irritate sensitive post-operative tissues. If the nasal reduction was combined with hematoma drainage, the doctor may prescribe prophylactic antibiotic therapy to eliminate the risk of perichondritis. Adherence to these guidelines ensures that the healing process will proceed without infectious complications.
Consequences of the failure to decide on a procedure such as nasal realignment
Failure to treat a displaced fracture carries a range of negative consequences, which may become apparent only after months or even years. Improperly healed bones can cause permanent deviation of the external nose, which many patients perceive as a significant aesthetic and psychological defect. However, much more serious is a deviated nasal septum, which occurs with almost every lateral injury. The failure to perform a nasal reduction procedure then leads to chronic obstruction, which in turn results in snoring, sleep apnea, and recurrent sinusitis.
In the case of an old injury, simple nose repositioning is no longer possible, and the only solution becomes osteotomy, which is the intentional breaking of the bone by a surgeon during a comprehensive plastic surgery procedure. This procedure is significantly more expensive, more invasive, and requires a longer absence from work or school. Therefore, specialists emphasize that nose repositioning in the so-called 'golden window' (a few days after the injury) is the safest and most effective form of assistance. Appropriate action immediately after the accident allows preserving natural facial features and the full physiological function of the nose for smell and breathing.
If you've suffered a nose injury and suspect it's broken, don't risk complications resulting from improper healing. Time plays a crucial role here, which is why it's worth trusting a specialist in facial surgery. I invite you for a professional consultation and potential nose realignment with plastic surgeon Dominik Boligłowa in Krakow. Thanks to many years of experience and an individual approach to each patient, it is possible to restore full functionality and the aesthetic appearance of the nose, even after complex injuries.
If you are considering a procedure for yourself, schedule a consultation – Dr. Boligłowa will recommend the best solution to help you achieve confidence and satisfaction with your appearance.
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