A broken nose, known medically as a nasal fracture, is one of the most common facial injuries, frequently affecting the bones and cartilage that form the nasal pyramid. The procedure to realign the displaced bone and cartilage fragments is medically termed nasal reduction. Improper manipulation can lead to permanent deformity or functional issues. Nasal fractures account for approximately half of all facial fractures, and they can cause difficulty breathing, significant cosmetic changes, and long-term problems if not treated correctly.
Immediate First Aid for Nasal Injuries
Following an injury, the immediate priority is to control any bleeding and minimize swelling before seeking medical attention. If the nose is bleeding, the person should lean forward slightly, rather than tilting the head back, to prevent blood from draining down the throat, which can cause nausea. Apply a cold compress or ice pack gently to the bridge of the nose for 10 to 15 minutes at a time, taking care not to apply excessive pressure that could shift the fractured bones further.
The application of ice helps constrict blood vessels, reducing pain and swelling. Over-the-counter pain relievers, such as acetaminophen, can be used to manage discomfort. However, non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided initially, as they can sometimes increase bleeding. Monitor the person’s breathing, especially if the injury has caused significant swelling or obstruction inside the nasal passages.
Medical Assessment and Determining the Need for Reduction
Once professional care is sought, a physician conducts a physical examination to diagnose the fracture and determine the best course of treatment. The doctor looks inside the nasal passages and feels the nose externally to check for bone mobility and deviation. They must rule out a septal hematoma—a collection of blood in the nasal septum—which requires immediate drainage to prevent cartilage damage and nasal collapse.
While X-rays or computed tomography (CT) scans can confirm a fracture, the diagnosis is often made based on the physical examination alone. The decision to perform a reduction is based on whether the fracture has caused a significant cosmetic deformity or a functional obstruction that impedes breathing. Reduction is typically delayed until the initial swelling subsides, which usually takes between three and seven days post-injury.
The Procedure: Nasal Bone Reduction Techniques
The technique used for nasal bone reduction depends largely on the complexity of the fracture. For simple, non-comminuted fractures where the fragments are not severely displaced, a closed reduction is the standard approach. This non-surgical method is often performed in an outpatient setting using local anesthesia and sedation to manage pain and anxiety.
During a closed reduction, the physician prepares the nasal cavity with cotton pledgets soaked in a local anesthetic and a vasoconstrictor to numb the area and minimize bleeding. Specialized instruments, such as a Boies nasal elevator or Walsham forceps, are then carefully inserted into the nostril. The elevator is used to gently lift and manipulate the displaced bone segments.
For more severe, complex, or comminuted fractures, or for injuries untreated for more than two weeks, an open reduction may be necessary. This is a surgical procedure performed in an operating room, typically under general anesthesia. It involves making small incisions to directly visualize and repair the bone and cartilage. The goal is to restore the normal alignment of the nasal structures.
Recovery and Long-Term Care
After the reduction procedure, both internal and external splints are used to maintain the new position of the bones. Internal splints, often made of silicone or soft packing material, are placed inside the nostrils to support the septum and prevent scar tissue formation. An external thermoplastic or plaster cast is applied over the bridge of the nose to protect the area and hold the nasal bones in place while they heal.
Patients should expect some degree of continued swelling and bruising around the eyes and nose for several days following the procedure. Pain medication is routinely prescribed to manage discomfort, and antibiotics may be given to prevent infection, especially if internal packing was used. The internal packing is typically removed within a few days to a week, with the external cast usually staying on for about seven to ten days.
During the recovery period, it is important to avoid activities that could cause re-injury, such as contact sports, for at least six weeks. Patients are also advised to avoid wearing glasses that rest on the bridge of the nose until the bone is stable, as this pressure can cause the bones to shift. Any persistent bleeding, signs of infection like fever or foul-smelling discharge, or severe, unremitting pain should prompt an immediate follow-up with the treating physician.