Nasal Fractures
In general, trauma that involves the bony part of the nose (the upper third) can be fixed in the immediate post-injury period. If a nasal fracture has displaced the nasal bones laterally (visibly moved the nose to one side causing a crooked appearance), it is best fixed with a closed nasal reduction. This can be performed within the first 5 hours of the injury or between 5 and 14 days after the injury. A closed nasal reduction involves simply moving the bones back to the midline and resetting them without making any internal or external incisions.
Traditionally, injuries that affect the cartilage of the nose (the lower two thirds of the nose) have only been addressed at a later date, usually 6-12 months after the injury. This practice was adopted in order to give enough time for all the nasal swelling to resolve, to be able to see contour irregularities in the nose that may not be obvious at the time of the injury. However, newer studies and Dr. Irvine’s own experience have demonstrated that in certain situations, it may be okay and even preferable to perform a complete rhinoplasty, addressing the nasal bones and the cartilage, at the time of the injury. Using powered ultrasonic instrumentation facilitates this. Dr. Irvine can delicately address nasal fractures without disrupting the framework of the nose, even when fractures are still mobile.
Regardless of the intervention chosen, treating displaced nasal injuries promptly is beneficial. Numerous studies have shown that even when the outcome of an immediate closed nasal reduction is not perfect, and even when a second surgery is still required, having an initial closed nasal reduction improves outcomes of secondary surgery.
Thus, Dr. Irvine and most urgent care and emergency room physicians encourage evaluation by an otolaryngologist or facial plastic surgeon within one week of nasal injury.
