The most commonly injured bone of the facial skeleton is the nasal bone. This occurs as a result of blunt trauma, auto accident, and sports injuries. Initially, the patient may notice only swelling, blood from nose (epistaxis), and pain. With swelling present, the actual fracture may easily be overlooked by the emergency room physician. Plain X-rays are not very useful in the diagnosis, often a CT scan should be seen to rule out more serious injuries.
Depressed fracture of nasal bone. (Illus. from Surgery of Facial Bone Fractures by John E. Sherman MD)
Treatment of Nasal Fractures
Treatment is relatively easy, and must be performed on a timely basis. These fractures are rarely treated acutely because of the swelling that is present. Dr. Sherman usually prefers to perform a manipulation of the bones (closed reduction of the fracture). This is done after four days when the swelling has subsided, the nasal bones may be easily seen to set correctly and before two weeks at which time the fracture is mostly healed. The procedure may be performed under local anesthesia or sedation anesthesia by a board-certified anesthesiologist. A closed reduction can be performed in the office setting, or as an out-patient at the hospital.
If the reduction is necessary after the 2 to 3 week interval of healing post-trauma, the patient should wait for at least two months for swelling and the nasal bones to fully heal. At that time, an open reduction of the nasal fracture is performed. This is usually performed under sedation anesthesia with an anesthesiologist.
Whether the fracture is treated by open reduction, or closed reduction, the patient wears a splint for about 6 to 7 days. The swelling is modest, and the patient usually can return to work After two days. You should be aware that the nasal bones can shift until fully set which takes about three to four weeks.
Even after the reduction of the nasal fracture, the patient may have difficulty breathing months later because of changes to the septal cartilage (septum). At that time, this may also be corrected with a septoplasty.
Figure A, B. Preoperative picture showing displaced fracture of the nose.
Figure C, D. Patient after corrective surgery restoring appropriate alignment and structure of nose.
