How do you fix a nasal fracture?

The outside of the nasal passages has bone and a cartilage that gives shape to the external nose. The lower part is made from cartilage that is mostly pliable and can withstand forces without breaking, and the upper part, between the eyes, is made from bone. Trauma to the outside of the nose can sometimes lead to fracture of the nasal bones. This could be in the form of a hairline fracture, and nondisplaced fracture where the bone fragments are still in the proper location, or a displaced nasal fracture which then distorts the external appearance of the nose. Often, nasal fractures are accompanied by severe nasal swelling as well as ecchymosis (black and blue formation). Frequently, nasal fractures can also be accompanied by nose bleeds.

The diagnosis of a nasal fracture can be confirmed in an emergency room setting, usually with the help of a nasal x-ray. If you are able to see your ear, nose, and throat specialist in a timely manner this can also be accomplished more professionally. A patient with a documented nasal fracture has a few options. In cases of hairline fracture or a nondisplaced nasal fracture, technically nothing needs to be done. Letting time for the bones to heal will ultimately restore the strength of the nasal bones.

A displaced nasal fracture usually needs more attention. This kind of a fracture does not necessarily mean obstruction of the nasal breathing passages, and is more of an external concern rather than an outstanding medical problem. The patient might choose to let the fracture be left alone, or have a closed reduction, or have a more open reduction. Closed reduction means that no incisions are made, and the bone fragments are popped back into proper alignment using devices that can accomplish this through the nostril. An open reduction means that incisions are made usually on the inside of the nose to visualize the broken bones in order to achieve better rate of success with realignment of the nasal fragments.

A closed nasal reduction could be accomplished immediately after the injury, before any significant swelling has evolved. This is usually within the first few hours after the injury. Unfortunately, most patients are not able to see an ENT specialist in that short amount of time, and by the time they are seen in the office there is quite a bit of swelling. This swelling prevents an accurate assessment of the location of the bones in order to achieve a better alignment. Alternatively, a closed reduction can be once again accomplished once the swelling has resolved after few days of waiting and application of ice packs to the nose. Most cases of closed reduction are achieved anywhere between 5 to 20 days after the initial injury.

If reduction of the nasal fracture has not been accomplished in the time frame as mentioned above, the bones then fuse in whatever locations they have been left. A patient who is seen quite a few weeks or few months after the injury has already bones that have healed and fused. The next option is to have an open nasal reduction. This is usually done in an operating room setting under anesthesia for most patients. Typically, the bones that have healed in a nonaligned location need to be refractured and reset into proper alignment.

The general recommendation is to have the nasal bones examined as soon as possible in order to assess if a fracture is present. A consultation with your ENT specialist, supplemented with appropriate X-Rays, will let you have a thorough evaluation and recommendations tapered to your specific needs.

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Posted in: Nose


Responses:

  1. Hi,
    Thanks for the article. I am looking for advice for my fiancé. His right nostril is completely closed and he’s unsure why. It has been in the process of closing for a while (not sure how long), but now it is completely closed. I have taken pictures of the inside of his nostril as best I can, which I can email you. We are looking for advice asap. He is wanting me to stick something up his nose to kind of force his nostril to open because it’s getting pretty annoying to him, but I’m not sure that’s such a great idea. He has no medical insurance and pretty much no money at all that he can spend on a doctor or surgery, so I’m hoping we can fix it at home.

    Thank you.

    Comment by Kelsey on April 3, 2018 at 5:27 pm

  2. It seems that what you are describing is a nasal valve collapse. This usually has to do more with the structural support of the cartilages withing the upper part of the nostrils. There are minor and major reconstructive procedures that can be done, based on the severity. Your best bet is to see a Plastic/Reconstructive specialist for an evaluation.

    Comment by DrNamdar on April 4, 2018 at 1:38 pm

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