Nasal fractures are the most commonly occurring type of fracture in the US. The nose may be injured during sports, altercations, motor vehicle accidents or other incidents of blunt facial trauma. This section will discuss nasal fractures and their management.
The nose is made up of bone and cartilage. The upper portion is bone, and the lower 2/3 is cartilage. The inside of the nose has two passageways – one on the right and another on the left. The wall of cartilage and bone that separates the two nasal passages is called the nasal septum. Ideally, the septum is nice and straight. Many people have some degree of curvature, naturally, of their nasal septum. If the curvature is too severe, though, the septum will block the airway passage on one or both sides.
Blunt trauma to the nose may cause fractures – of the bones, the cartilage, or both. Most nasal fractures do not require treatment. If the fracture segments are not very displaced, then they will heal well without any problems. However, significant displacement (meaning that the bones or cartilage have been pushed far from their normal positions) can cause two potential problems. The first is a deformity that is visible. The second is obstructed breathing. So, it is important to remember that having a nasal fracture does not mean that it needs to be treated. It is treated if it causes problems - a deformed nose, or one that doesn’t allow you to breathe well.
When someone suffers a nasal fracture, there is typically bleeding from the nose. This can be pretty severe. It is best to seek prompt medical attention. The doctor in the emergency room, urgent care, or clinic can do a thorough exam, and determine if there are any associated injuries. Many times, x-rays or CAT scans are obtained. These are not always that helpful in diagnosing nasal fractures. If there are no other injuries, then the doctor will usually advise that the patient to schedule a follow-up with a specialist in a few days. This can be an Ear Nose and Throat doctor (Otolaryngologist), Plastic Surgeon, Facial Plastic Surgeon, or an oral and maxillofacial surgeon.
It is often best to see the specialist 3-7 days after the incident. This is because it is often difficult to determine if the patient has a broken nose in the first few days because it is typically quite swollen. After several days, once the swelling has subsided, the doctor can better examine the nose and determine if there is significant displacement. The specialist will then let the patient know if there is a fracture that needs to be fixed. Many patients will ultimately choose to undergo a procedure to correct the visible deformity.
The nasal bones or the septum may be fractured. Sometimes both are fractured. If the nasal bones are fractured but the nasal septum is straight, then a simple “closed reduction” may suffice. This is a pretty simple procedure in which the nasal bones are “pushed” into the correct position. Often, some packing and perhaps a cast are then placed to stabilize the healing bones. The window of opportunity to perform this procedure is within the first 2-3 weeks after the injury. This is because the bones will start to heal in the deformed position after around 3 weeks. During this window, the procedure can be done in the office under local anesthesia, but many patients prefer to be sedated or asleep for the procedure, in an operating room.
If the decision to perform the closed reduction is delayed until after a few weeks, then it is often no longer possible to perform the simple closed reduction. In such cases, the bones must be surgically re-broken in order to position them accurately. This is an “open” reduction, and must be performed in the operating room.
Another reason to have the nose treated surgically is to address any distortion of the nasal septum. This requires incisions inside the nose, with repositioning of the cartilage portion of the septum. It can be combined with repositioning of the bones. This is a version of a procedure called a “septorhinoplasty” – where the nose is reshaped to improve the appearance, the function, or both.
It is important for several days after surgery to avoid bending over or heavy lifting. The nose takes about three weeks to heal to the point that no restrictions are necessary. It continues to undergo healing for quite a few months after that, as the final amount of swelling resolves.
Generally, the answer is yes. A nasal fracture that is displaced, and thus creates a visible deformity and/or a problem with breathing, is a medical condition that is appropriate for coverage by your medical insurance. This is true for early fractures that are treated with closed reduction, as well as those cases treated later which require more extensive surgery in order to correct the obstruction and/or deformity.
The issue becomes less clear for patients who desire a change in their appearance, which cannot be attributable to any trauma to the nose. In such cases, the purpose of the procedure is considered cosmetic and the procedure will not be covered by insurance plans.