The nose, in addition to being the way we smell, is also a part of our body's respiratory system. The nose has long been regarded as an important component of human beauty and facial harmony. This is unavoidable when it's the most protruding part of our face, right in the middle, "standing out"... quite literally. Unfortunately, the nose's prominent but unprotected position exposes it to accidents and assaults.
Thousands of people break their noses each year. Trauma is the most common cause, and it is frequently caused by car accidents, fights, sports injuries, and falls. Rhinoplasty is frequently required to repair a broken nose. A broken nose can have one or more fractures; the techniques used to repair them will vary depending on the type of injury and location, the part of the nose that is broken, and other factors. The nasal bone can usually be reset if the procedure is performed within 10 days. If not, it may be necessary to wait three months or more. Any reconstructive surgery will have to wait until the swelling has gone down.
A broken nose, also known as a nasal fracture or nose fracture, is a break or crack in the nose's bones. It frequently occurs over the nasal bridge and involves nearby cartilage (the soft parts of your nose), particularly the septum. On the inside, the nasal septum is the flexible wall that separates your left and right nostrils. The severity of a fractured nose can vary. A milder fracture may be accompanied by minor swelling or a brief nosebleed. The break may go unnoticed until it heals with a slight deformity.
Severe fractures, however, present with a hard to miss deformity, with the nose often shifting from its normal midline position right after impact. It also may be accompanied by heavier nosebleeds, a blocked nostril, or even impaired airflow.
As mentioned before, the nose’s anatomy and position make it a prime target for various injuries. A broken nose makes up to 40% of facial fractures. Therefore, any activity that has the potential to cause a facial injury, increases the risk of procuring a broken nose. Here are some of the most common causes for a fractured nose:
. These are sports that involve physical contact between players.
. Acquiring a nose sports injury is very common in rugby, hockey, and American football.
. In any form, be it on a professional level (boxing, MMA, UFC, etc…) or regular altercations.
. Driving a car without a seat belt on or riding a bike without protective gear significantly increase your chances of nose trauma.
. A broken nose can be the result of falling from a bike, skateboard, rollerblades, or pure clumsiness.
It is important to note that due to their immature bones being somewhat flexible, children carry a lower risk of nasal fractures. However, if acquired, they are more likely to suffer from long-term deformities and breathing difficulties. In neonates, traumatic nasal injuries can occur during delivery. Toddlers can fall on their face learning to walk, or afterwards. In older children, a nose fracture is more likely to occur from the causes mentioned earlier.
While sustaining a nose injury is sometimes inevitable, there are certain guidelines you can follow to help minimize the risk of nasal fracture:
. Being buckled up during a car accident helps keep you safe inside your car.
. It reduces the risk of suffering from a smashed nose by nearly half.
. Seatbelts are for everyone, so always make sure younger children are in age-appropriate child safety seats as well.
. Sports that carry a significant risk for head and nose injuries (American football, bicycling, hockey) often mandate the use of helmets as part of the uniform.
. You should also wear a helmet when riding a motorcycle or bicycle.
. In sports like rugby, professional fighting, basketball, and soccer, a faceguard is always an option to protect your face from nasal injuries, as well as, maxillary, zygomatic, and orbital bone fractures.
Signs and symptoms of a fractured nose can appear immediately after impact or can take up to 3 days to show. Swelling can make an accurate assessment of the extent of nose damage difficult, other symptoms include:
. Especially when touching your nose. It can be accompanied by a cringeworthy crunching sound (called crepitus)
. Bruising: A discoloration may appear around your nose area and eyes. This is due to capillary disruption, and accumulation of blood beneath the skin’s surface.
. Nosebleeds: Can range in severity. A heavy or continuous blood flow is a warning sign to seek out immediate professional help.
. Rhinorrhea: Another medical emergency. A clear discharge from your nose may signify leakage of cerebrospinal fluid (brain fluid). This usually happens due to the disruption of the thin fovea ethmoidal, a bony plate that forms part of your skull base, separating the brain from the sinuses.
. Breathing difficulties: This can be a direct result of nose swelling, dried blood, or a deviated septum.
. Crooked nose: You may notice that your nose has taken a misshapen look and is no longer as straight as before.
If your nasal injury is not severe, accompanied only by mild swelling and pain, it’s best to allow your swelling to subside. You and your doctor can better assess your nose injury then. However, the general advice is to not wait longer than a week. Severe nose trauma requires more prompt medical attention.
During your appointment, your doctor will gently prod your nose and surrounding areas. They will examine your nasal passage to check for signs of bone damage or obstruction. Your doctor may use Anesthetics (nasal spray or local injections) to make the physical exam more comfortable. You will need to explain how you sustained your injury, as well as, your medical and surgical history, allergies, and any current medications.
X-rays are rarely needed to diagnose a broken nose. However, your physician may implement a computerized tomography (CT) scan if your nasal injuries are so severe that physical examination is impossible, or if they suspect multiple injuries.
Doctors do not routinely recommend scans or X-rays. A crack in the bone where the nose hasn’t shifted (undisplaced fracture) can be difficult to diagnose, and since it does not require treatment, attempting to make the diagnosis is not worthwhile.
The aftermath of a fractured nose can range in severity. Here are some possible complications of a broken nose:
. A common complication of nasal fractures.
. The nasal septum is the thin wall separating your right and left nostrils on the inside.
. Septal deviation occurs when your nasal septum is displaced. This narrows your airways and causes breathing difficulties.
. This can usually be easily straightened within 10-14 days, or the nose will remain deviated unless formal Rhinoplasty is performed.
. An emergency condition that requires immediate surgical drainage to prevent cartilage injury.
. It is when blood pools and collects in a broken bone, blocking one or both nostrils.
. Septal hematoma can lead to a septal perforation, and/or saddle nose, especially if an infection of nasal bacteria occurs, which can lead to a septal abscess.
. Cartilage is the soft compressible part of your nose.
. It can be smashed as a result of a forceful impact, most often from a motor vehicle accident.
. Severe nose injury may warrant surgical intervention (rhinoplasty).
. Disruption of the nasal architecture leaves the nose prone to bacterial invasion.
. This could spread to nearby sinuses, facial bones, and even your brain (meningitis).
. All nose fractures carry the risk of olfactory impairment.
. This can range from decreased smell detection ability (hyposmia) up to complete lack of smell (anosmia).
If your nose injury doesn’t warrant immediate medical attention and does not cause significant problems, it is safe to follow these suggestions before seeing a doctor:
. Apply a pack of ice wrapped in a towel or its equivalent (bag of frozen peas) on your fractured nose for 15 mins, several times a day.
. Pain relief: You may use over-the-counter medication such as paracetamol or ibuprofen for symptom control.
. Nosebleed control: Sit down, lean forward, and pinch the soft part of your nose above the nostrils – only if possible. Avoid tilting your head backwards as is common, this will drain blood into the back of your throat.
. Swelling reduction: To ease nose swelling, keep your head upright by stacking pillows when lying down.
In addition to these self-care tips, there are some important “don’ts” that should be aware of while your nose takes its time to heal.
. Don’t feel emboldened to straighten out your nose yourself. Seek out a qualified physician instead.
. Avoid wearing spectacles until your swelling has gone down significantly.
. Restrain yourself from blowing or picking out your nose. This may exacerbate your injury.
. For the first 2 weeks, allow your nose to heal properly and avoid any strenuous activity.
. Don’t participate in any sporting activity for at least 6 weeks. There’s always a chance you might hit your face…again.
If you’ve been in an accident, emergency care will be provided to you at the emergency room. After addressing the more serious injuries, they will refer you to an ENT surgeon or plastic surgeon to assess your broken nose and decide if you need intervention. Here are the possible approaches to deal with a broken nose;
. Over-the-counter medication:
. This includes analgesics such as acetaminophen (paracetamol) that provide pain relief.
. Nasal decongestants may alleviate swelling by constricting mucosal blood vessels.
. Antibiotics: your doctor may prescribe Empiric antimicrobial therapy as prophylaxis. An injured nose is vulnerable to infections.
. If the nose is not straight on the outside, it will need to be straightened.
. You will not require a nasal pack.
This refers to the process of removing all thickened, infected, and nonviable tissues and debris.
If an open wound is present, a thorough debridement is necessary.
. Nasal packing
If the bleeding persists, your nose may be packed with a hemostatic sponge or gauze.
. Surgical draining
A septal hematoma is a medical emergency.
It must be drained or incised with the help of local anaesthesia to prevent serious complications.
Nasal reconstruction by an experienced surgeon is often needed to repair a broken nose, even after reduction, if the aesthetic outcomes of closed reduction techniques are less than desirable.
A rhinoplasty allows your surgeon to fix your broken nose and improve its features to meet your desired look. For example, if you have a large dorsal hump (bridge), overly projecting tip, or notched nostrils, your surgeon can address it during the same procedure.
there are two techniques when it comes to performing a nose job; The open technique (small skin incision between your nostrils) or a closed technique (no outer skin incision). This depends on the type of injury and deformity you have and what you want to be done.
This is the surgical correction of defects involving the nasal septum, which often sustains damage in nose trauma. The surgery improves airflow and breathing. When both the nasal septum and nose appearance need fixing, the procedure is called septo-rhinoplasty.
A broken nose may consist of one or more fractures. The techniques your surgeon uses to fix your nose will depend on how many fractures there are, their location and many other factors. Some people are unhappy with the appearance of their nose even prior to breaking it, and therefore opt to have cosmetic rhinoplasty in addition to reconstructive surgery. That being said, any surgery to fix a broken nose will take into account the appearance as well as address functional issues.
Usually, small internal incisions are made and the surgeon accesses the obstructive, deviated and/or damaged tissues and structures. He or she may use 3D imaging to get a better view and minimize trauma as well as recovery time. Tiny instruments will be used to manipulate and alter the nasal tissues and structures as needed. If necessary, cartilage grafts may be used to provide extra support in areas that have been damaged.
During the first 10 days, it may be possible to reset the nose with a closed rhinoplasty procedure, which involves only internal incisions. If more time has passed, it is more likely that more involved procedures such as septoplasty will be needed.
It should be noted that tip fractures are much less common than damage to the septum and surrounding nasal bones. If you do notice a deformity in the tip following an accident, it may be that the tip cartilages are displaced. In other cases, damage to the septum has caused the tip to droop.
A fractured septum is usually twisted and will need to be reset. This is important not just for form but also function (i.e., breathing). Some patients will require spreader grafts to strengthen the cartilage.
Again, it is important to remember that the nasal bone can be reset following the injury if the procedure is performed within 10 days. Otherwise, it is necessary to wait a few weeks to a few months, to allow the swelling to go down.
The majority of patients, will not need to have their noses packed or splinted. Like any surgical procedure, pain, swelling, and bruising are to be expected. They are most noticeable in the first week after surgery, before starting to fade. The bruising and tenderness can extend to your cheeks and under-eye area. This is not unusual and is the result of inevitable blood vessel damage during the procedure. It typically resolves within days. You should take at least 2 weeks off after surgery to allow yourself proper recovery and rest.
Perhaps one of the most crucial things to keep in mind after undergoing a nose job is that the road to full recovery is long. That’s not to say that you won’t notice any changes. Initial results start to show within 1 month, as the tissue begins to heal, and the swelling starts to subside.
Unlike other body parts, the soft tissue of the nose tends to retain swelling longer. Therefore, despite noticing remarkable changes within the first few weeks, the final nose contour will take several months, and even up to a year, to emerge.
Your surgeon will provide you with guidance to ensure you get the best possible results. This includes post-operative care, medication schedules, and what signs to look out for.
In addition to repairing your nose and preventing complications, broken nose surgery allows you to customize the appearance of your nose to your liking. Studies have shown that in the right hands, the positive long-term effects of rhinoplasty are not limited to what is visible. The remarkable psychological outcome may outweigh any functional or aesthetic advantages. Rhinoplasty can give you the confidence boost you've been missing and improve your chances in life. It promotes a more positive self-image, which influences how you carry yourself in public and how others perceive you.
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For more information about the cost of Broken Nose Rhinoplasty in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.