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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.
Nasal reconstruction involves aesthetic details and alterations that cannot be hidden under any apparel. Even the slightest of the changes in the 3 dimensions of the nose can have many ramifications for a person’s face. This makes nasal reconstruction surgery one of the most difficult surgeries due to the nuances involved.
Reasons for nasal reconstruction
The ultimate goal of any nasal construction surgery is to restore or refine the appearance and function of the nose. There are many causes that can lead to nasal abnormalities, such as:
- Accidents
- Physical altercations
- Congenital defects
- Any previous surgeries
There are several techniques that are used by a surgeon for reconstructing the nose. Depending upon the size, location, shape and the depth of deformity or defect, the surgeon decides which one to use. Some of the techniques used for nasal reconstruction are:
- Cartilage grafts
- Regional flaps
- Local flaps
- Skin grafts
- Secondary intention healing
- Suture closure
Every technique has its own advantage and disadvantage. In some cases, if required, a combination of these techniques can also be used.
Recovery time
Depending on which technique is used, nasal reconstruction recovery time varies from one person to another. For reconstruction surgeries involving smaller defects, the recovery period ranges from 1-2 weeks. Sutures are removed around 5-7 days after the procedure. The scars and incisions may appear to be red and raised initially but fade away gradually over the next few weeks. Normal activities can be resumed after 10-14 days. However, a large reconstructive surgery requires a period of over 3-8 weeks for recovery. Recovery time, too, increases depending upon the level of procedure performed. Many large procedures are often followed up by smaller touch-ups and revisions that are performed several months after the major surgery to improve the total nasal aesthetics.
Schedule a Consultation Today
Contact our office today to schedule a consultation for your nasal reconstruction in New York City. Dr Sherman is a skilled and experienced plastic and reconstructive surgeon who strives to provide all of our patients with the exceptional care and results they are in need of.
