A nasal fracture can be caused by blunt force to the face during a car accident or an elbow smacking your nose while playing basketball. Many broken noses can be repositioned, splinted and taped to restore the shape. While not all broken noses require surgery or repair, if it impacts your nose function or appearance, you may need the expertise of a skilled facial plastic surgeon like Dr. Gary Linkov. City Facial Plastics, located in Manhattan, NY, offers exceptional nasal fractures repair for those who have suffered damage to the nose.
What Are Nasal Fractures?
A nasal fracture is more commonly known as a “broken nose”. The nose is composed of several bones, and one or more of these bones may be fractures during a facial injury. What causes a nasal fracture? There are many causes of nasal fractures, but common causes include falls, sports injury, physical altercations, and motor vehicle accidents. Symptoms of nasal bone fractures include swelling, bruising, pain, change of shape, and nosebleed. Many people ask “Can nasal fracture cause sleep apnea?” Nasal fractures are unlikely to cause sleep apnea.
A nasal fracture is not only physically painful but can also cause a strong emotional and psychological impact by altering one’s appearance. Nasal bone fractures are common, comprising 40% of all facial traumas. No matter the cause of nasal fracture, it is important to understand the healing process and options for treatment.
What Is the Relevant Anatomy for Nasal Fracture?
The nose is particularly prone to injury as it is the most prominent facial feature. The nose is primarily made of cartilage, however the upper part is made of bone. The upper paired nasal bones are the typical site of injury during nasal fracture. The nasal septum, which is made mostly of cartilage and separates the right and left sides of the nose, may also be fractured during nasal injury.
How Is a Nasal Fracture in Manhattan, NYC Diagnosed?
Nasal fractures can be diagnosed by an radiograph image, also known as an x-ray or a CT scan. However, nasal fractures are best identified via physical examination by pressing on the top of the nose and feeling a “step off”, corresponding to the site of malposition of the bone. Can nasal fracture cause a deviated septum? The initial trauma to the nose may cause the septum to shift independent of the nasal bone. Thus, you can have a nasal septum fracture or deviation either with or without a nasal bone fracture.
When to Reduce a Nasal Fracture?
Nasal fractures are usually not repaired on the day of injury due to the significant swelling that occurs with the injury. After several days have passed and swelling has decreased, a nasal fracture treatment called a closed reduction nasal fracture surgery can be performed.
This type of nose fracture treatment should be done within 10-14 days of the nasal injury, while the bones can still be easily manipulated. For people who do not seek medical attention right away after suffering a nasal bone fracture, rhinoplasty may be required for repair in a delayed fashion, at least 6 months after the injury.
Who Is a Good Candidate for Nasal Fracture Repair?
A nasal fracture alone is not enough of an indication for nose fractures repair. The best candidates for nasal fracture repair in New York City include patients with:
- Nasal obstruction as a result of the nasal fracture injury
- Cosmetic nasal change from the nasal fracture injury
One or both of these criteria should be met before having nasal fracture repair surgery. If neither criteria are met, the nose can simply be observed in most instances.
Do You Need Nose Surgery?
Nose fractures change the structure of the nose both inside and out. Many times, a nose fracture is allowed to heal and not positioned correctly. There can be damage to the septum or other internal components that interfere with breathing. The nose also may heal crooked, changing the appearance of the nose. Rhinoplasty restores function and shape to the nose, even for nose fractures that have already healed.
How Is Nasal Plastic Surgery Done?
Closed reduction nasal fracture surgery is indicated for acute nasal bone fractures with functional or cosmetic consequences. In this type of surgery, there are no incisions made on the skin. Rather, the surgical instruments are inserted into the nostril after adequate decongestion is achieved.
Using these instruments, Dr. Linkov manipulates the bones and surrounding nasal structures in such a way that restores the fractured nasal bones to their normal position. The repositioned bones are then kept in place with internal absorbable packing and/or an external splint along the bridge of the nose.
How to Prepare for a Nose Surgery?
Once you have been recommended for closed reduction nasal fracture surgery for nasal bone fracture, there are several steps you should take to prepare for the procedure. These steps include:
- Avoiding certain medications and supplements that may thin the blood, such as NSAIDs (i.e. ibuprofen and naproxen), aspirin, warfarin, and vitamin E.
- Pick up medications at the pharmacy, as Dr. Linkov at City Facial Plastics in UES, Manhattan may prescribe you certain medications to take before and/or after the closed reduction nasal fracture surgery, such as an antibiotic and pain medication.
- Identify an escort home, as you will need someone to accompany you home if you receive sedative medication during your closed reduction nasal fracture surgery.
- Do not eat or drink after midnight the night prior to your closed reduction nasal fracture surgery.
What to Expect on the Day of a Nose Job Procedure?
On the day of your procedure at City Facial Plastics in Manhattan’s Upper East Side, you will meet with an anesthesiologist to review your medical history before receiving anesthesia. For closed reduction nasal fracture surgery, either deep sedation anesthesia or general anesthesia is administered based on the anticipated complexity of the surgery and your personal medical history.
You will receive an antibiotic, either oral or intravenous, prior to surgery to help reduce the risk of infection. Once you have received the antibiotic and anesthesia, Dr. Linkov will start the surgery. Closed reduction nasal fracture surgery usually takes between 30 to 60 minutes.
What Is the Recovery From Closed Reduction Nasal Fracture Surgery?
A cast is placed externally on the nose after the completion of the closed reduction nasal fracture surgery. This cast is removed in the office one week after the surgery. Internal packing may be placed inside of the nose to help stabilize the nasal structures, and this packing will dissolve on its own. Bruising and swelling are common after closed reduction nasal fracture surgery and may take 1-2 weeks to resolve.
For the first week following the nose plastic surgery, the following steps should be taken to prevent nosebleed:
- Keep the head of your bed elevated at least 30 degrees
- Sneeze with your mouth open
- Avoid blowing your nose
- Avoid heavy lifting
What Are the Risks and Complications of Closed Reduction Nasal Fracture Surgery?
While closed reduction nasal fracture surgery is typically needed after nasal bone fracture to restore normal function and appearance of the nose, there are complications that can occur.
Some of the risks and complications of this type of nose plastic surgery are described below.
Significant bleeding is rare after closed reduction nasal fracture surgery. It is normal to experience some minor nose bleeding either from the nostril or back of the throat within the first few days after nose surgery. The nose may be packed to reduce the risk of bleeding.
Infection can occur after closed reduction nasal fracture surgery but this is also rare. Antibiotics are typically administered either orally or intravenously before the surgery to reduce the risk of infection. You may be prescribed antibiotics to take for several days after closed reduction nasal fracture surgery as well.
Saddle nose deformity
Saddle nose deformity can occur as a result of the initial nasal injury or as a complication from infection. This deformity is also known as “boxer’s nose” or “pug’s nose”, and refers to the loss of nasal height. Rhinoplasty is typically required to fix saddle nose deformity.
Instability of nasal structures/incomplete repair
While the goal of closed reduction nasal fracture surgery is to repair the nasal bone fracture, some of the surrounding nasal structures may become unstable during the surgery. It is important to note, however, that some of these structures may have been injured as a result of the initial facial trauma.
Need for revision surgery
Some people may experience nasal asymmetry and bony and cartilaginous abnormalities as a result of the initial nasal fracture or repair. These features can be aesthetically unpleasing and bothersome to the patient and may require revision nose surgery or rhinoplasty to correct.
What Are the Contraindications for Closed Reduction Nasal Fracture Surgery?
There are some reasons why a person may not be a candidate for closed reduction nasal fracture surgery after suffering a nasal bone fracture.
Potential contraindications to nasal fracture surgery include:
- Severe kidney, liver, or cardiac disease, unless cleared by a specialist for anesthesia and surgery
- Poorly controlled diabetes
- Allergy to certain anesthesia medications
What Are the Alternatives to Closed Reduction Nasal Fracture Surgery?
There are two main alternatives to closed reduction nasal fracture surgery: no surgery at all or open reduction nasal fracture surgery.
No surgery approach to nasal bone fracture
One option for people who have nasal bone fracture is to not undergo reparative nose surgery at all. This is typically reserved for people with minor nasal bone fractures that do not cause significant physical or functional deformity, or for those with significant medical problems in whom the risks of nose plastic surgery and anesthesia are high.
Open reduction nasal fracture surgery
Open reduction nasal fracture surgery, which is essentially a type of rhinoplasty, is an option for people seeking care after the 10-day period following the injury that caused a nasal bone fracture. For various reasons, some people cannot or do not want to undergo closed reduction nasal fracture surgery right away.
Other people do not seek medical care after the initial facial trauma and are unaware that they even had a nasal bone fracture until months later. The open reduction, during which the nasal bones are rebroken, is typically delayed at least 6 months after the initial injury.
Who Is the Best Nasal Fracture Plastic Surgeon in NYC?
Dr. Gary Linkov is a board-certified facial plastic surgeon in New York. Given his extensive training in both facial trauma and cosmetic surgery, he understands the need to balance one’s aesthetics and physical appearance while maintaining and restoring the nasal function.
Nose fractures are easier to repair before they heal. If you have a broken nose, seeking a consultation with a facial plastic surgeon is a good idea. It is important to ensure your nose will heal properly without airway blockages or changes to the shape. Contact City Facial Plastics in Midtown, Manhattan today to schedule a consultation with an internationally recognized plastic surgeon Dr. Gary Linkov if you have a nose fracture that may need repair or rhinoplasty.