Straightening a broken nose is a type of fracture reduction, performed in a closed manner with instruments to grasp and manipulate the bones back into place through the skin, or in an open surgery called a rhinoplasty. Closed manipulation can be performed by an experienced physician in an office or emergency department. A rhinoplasty is a complex reconstructive operation performed by a specialist to achieve individualised cosmetic and functional results.
- Skill level:
Things you need
- Old picture
- Licensed health professional
- Driver/Responsible adult (if sedation is used)
- Nasal Speculum
- Local Anesthetic
- Asch forceps
- Boies Elevator
- Monitoring equipment
- Suction equipment
- Resuscitation equipment and medications
- Access to operating room and ear, nose and throat surgeon
Decide with the doctor's advice if manipulation without open surgery is right for you. The closed method can straighten simple fractures, nasal septum complex fractures deviating less than one half the width of the nasal bridge and deviations that block breathing or mucus drainage. This method is not appropriate if there is a complex fracture, open fracture, or basilar skull fracture.
Choose the best time and specialist. An emergency physician can achieve proper alignment within hours of the injury before swelling sets in, but there is no evidence that manipulation immediately after injury will result in a better functional and cosmetic outcome. Emergency physicians do not provide continuing care or rhinoplasty.
Wait three to five days after injury for swelling to go down, but do not delay until the bones set out of place (about 10 days). At that time, an ENT (ear nose and throat) surgeon or plastic surgeon can perform closed straightening and advise you on the specific techniques used in rhinoplasty. Some doctors will manipulate the nose up to three weeks after injury, while others wait months to achieve predictable results. Ask about the availability of the surgeon for follow up care after business hours if you have a problem.
Bring an old picture to the ENT or plastic surgeon. Up to 30 per cent of patients have a pre-existing asymmetry. The physician will not manipulate the fracture if the asymmetry is not a result of the injury, however rhinoplasty and cosmetic surgery may fix minor cosmetic defects. These specialists have special training in cosmetic and reconstructive surgery of the face and can advise you on the full range of treatments available.
Choose the Technique, Time, and Specialist
Choose a physician who will perform the procedure in a monitored setting with the availability of suction and resuscitation equipment if serious bleeding occurs.
Discuss risks and complications with your doctor before any procedure. Complications can include bleeding, infection, sinusitis, breathing problems, cosmetic deformity, rare brain infections, and rare side effects of anaesthesia such as strokes, seizures, heart problems and even death.
Obtain written after care instructions including the exact name of the procedure and any medications you were given in case you need emergency care later.
Discuss pain management options with your doctor. To numb the nose, swabs soaked in anesthetic may be inserted, or sprays, local injections and nerve blocks may be chosen. Intravenous sedating medication may be chosen, but monitoring is necessary and you will need a responsible adult to accompany you home.
Allow the doctor to insert a speculum (a metal device to spread the nostrils) to look for bleeding, clear cerebrospinal fluid (CSF), or a blood clot called a septal hematoma. If present, the doctor will cut open and drain the hematoma. If CSF is present the closed method should not be used.
Ask your doctor which instruments will be used to manipulate the nasal bones back into place. A Boies elevator lifts the displaced bone while the doctor applies pressure to reposition the broken fragments. Asch forceps are inserted gently into the nostril to grasp the displaced fragments and move them back into position. Excessive force can crush the nasal tissue causing bleeding.
Ask the doctor for a mirror to see if you are happy with the position of the nose. A splint is then applied to the nose for a week. An antibiotic and pain medicine may be prescribed, and the doctor will instruct you on reasons to return such as signs of infection, excessive bleeding, deformity, or lack of mucus drainage.
The Closed Method
Tips and warnings
- Seek the care of a doctor first, serious injuries associated with a broken nose can cause death or permanent disability.
- Fights and abuse commonly cause broken noses. Appropriate authorities must be informed if abuse is suspected or assault with a deadly weapon occurred.
- Manipulation of a broken nose may cause serious bleeding (which could require an emergency operation if uncontrolled), a break of the bone between the nose and brain leading to brain infection, cosmetic nose deformity, sinusitis, and a black eye.
- The anesthetics used to treat a broken nose rarely cause heart problems, seizures, strokes, and even death.
- If sedation is used by the physician in a monitored setting, a responsible adult should accompany the patient safely home.
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