Nose fracture
Although I have over 10 years’ general experience in university hospitals in facial traumatology, I now only perform fracture reduction of the clean bones of the nose.
Nose-bones
The nose is made up of bones and cartilage. On the outside, the nose is made up of 2 bones at the top, and upper and lower lateral cartilages at the bottom and nasal septum cartilage inside. When a strong trauma impacts the nose, the nose bones can be broken and displaced, along with the upper maxillary processes that hold them in place. The septum may also be affected, leading to the development of a septal hematoma that must be drained.
Indications, objectives and target audience
Wether for adults or children, fractures of the nasal bones should be reduced in cases of recent post-traumatic deviation of the nasal pyramid.
Objectives are :
- Restore a satisfactory aesthetic appearance to the nasal pyramid.
- Restore a feeling of freer airflow to the nasal cavity on inspiration.
There are several important points to bear in mind :
- Examination by an ENT specialist is advisable after significant trauma to the nose, in particular to rule out nasal septum hematoma, which can be complicated by infection and deformities of the nasal tip.
- Not all fractures of the clean bones of the nose need to be operated on; only those with a visible unsightly deformity or functional impairment are concerned.
- You need to wait a few days after a trauma to judge whether or not surgery is necessary. This is because the nose swells and its edges fade with post-traumatic oedema. Ideally, ice should be applied and the ENT specialist should be consulted 4-5 days after the trauma.
- Surgery should be performed within 10 days of the trauma, before the bone refixes in a vicious position.
- If your trauma dates back further in time, the surgery is totally different called rhinoplasty.
The different stages of the intervention
The surgical procedure
Under general anaesthesia in an outpatient operating room, a non-invasive instrument is introduced into the nasal cavity, and a gentle, gradual manual reduction of the fracture is performed until satisfactory reduction is achieved. Wicks are then placed in both nasal cavities to hold the bone reduction in place. The drill bits are subsequently removed. At the end of the operation, a plaster cast or resin is placed over the nose, not to support it, but to protect it from pain and secondary displacement in the event of further impact. The plaster or resin should be kept on for 2 weeks, and the bits for 24 hours.
Post-surgery recovery period
The patient returns home the same day.
You may be off work for up to 14 days, depending on your profession.
Pain is moderate. Class I analgesics are used to control pain.
Post-operative care at home: nose washed with saline several times a day for 21-30 days until all crusting has disappeared.
Scarring: no visible scarring.
Precautions: do not play sports involving contact with the nose (basketball, soccer, handball, volleyball, combat sports, etc.), or carry small children or animals that could make uncontrolled movements against your nose, for 6 weeks.
Complications associated with nasal bone fractures
In addition to the risks inherent in any surgery involving general anesthesia, the reduction of fractures of the nasal bones presents the following risks of side effects or complications:
- Very moderate nasal haemorrhage of small volume (a few minutes) when the wicks are removed.
- Hematoma around the eyes, which may already be present prior to surgery due to trauma.
- Nose edema.
- Nasal discomfort.
- Transient lacrimation.
- Residual deviation of the septum.
- Residual deviation of the nose: the nose may not return exactly to its original shape.
- Infection of nasal cartilage or chondritis.
Please refer to the College of ENT’s Fact Sheet on reduction of clean-bone fractures of the nose for further explanations and exceptional complications: Fracture des os propres du nez
There are several important points to bear in mind
- Examination by an ENT specialist is advisable after significant trauma to the nose, in particular to rule out nasal septum hematoma, which can be complicated by infection and deformities of the nasal tip.
- Not all fractures of the clean bones of the nose need to be operated on; only those with a visible unsightly deformity or functional impairment are concerned.
- You need to wait a few days after a trauma to judge whether or not surgery is necessary. This is because the nose swells and its edges fade with post-traumatic oedema. Ideally, ice should be applied and the ENT specialist should be consulted 4-5 days after the trauma.
- Surgery should be performed within 10 days of the trauma, before the bone refixes in a vicious position.
- If your trauma dates back further in time, the surgery is totally different called rhinoplasty.
Frequently asked questions
Here is a selection of the questions most frequently asked by Dr Delagranda’s patients during consultations for nose fractures in La Roche-sur-Yon.
Is the operation compulsory?
No, it is purely functional.
Is the result immediate?
Yes, but you may have to wait a few days for the nose to deflate before you see any results.
Does the reduction of fractures of the bones proper of the nose alter the functions of my nose?
Under no circumstances.
Fees and coverage of the procedure
Fracture reduction of the clean bones of the nose is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda will be happy to answer any questions you may have about reducing fractures of the bones proper of the nose. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vendée.
ENT consultation for fractures of the clean bones of the nose in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about reducing fractures of the bones proper of the nose. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon, Vendée.