Nasal bones are two paired bones situated as a wall of pyramid on both sides of upper one third of the nose. Both nasal bones are separated in midline by the nasal septum which devides two nasal cavities. Nasal bones are very thin yet moderately strong bones supported on both sides by frontal process of maxilla (upper jaw) bone and below the nasal bones, there are cartilages of nose responsible for shape and support of lower two thirds of nose. Because of there prominent location on the face and their thin structure, nasal bones are commonly fractured even by moderate force. Injuries which can lead to nasal bone fracture include road traffic accidents, sports injuries, assaults and domestic accidents. Not all nasal bone fractures require treatment. Nasal bone fracture can lead to two types of problems: aesthetic or functional and both. Indication of surgery for nasal bone fracture is decided by the plastic surgeon after reviewing the history and physical examination of the patient.
The symptoms of nasal bone fracture include bleeding from one or both nostrils (not always present), obstructed one or both nostrils with difficulty in breathing (not always), pain, abnormal movements and sometimes palpable step at fracture site and visible deviation of nasal bones causing aesthetic deformity of nose. Many times patient with nasal bone fracture presents to a plastic surgeon only after he/she notices deviation/deformity of the nose or told so by his/her family members. In case of more severe injuries, patients with nasal bone fracture have associated skin and soft tissue injury with possible fracture of other facial bones. Patients with nasal bone fracture develop significant soft tissue swelling over nose and adjacent area of eyelids and cheek within few hours of injury, which sometimes compell the plastic surgeon to delay the physical examination for a couple of days.
The most common cause of nasal bone fracture is road traffic accident. Not only car accidents, but two wheeler or bicycle accident can also cause nasal bone fractures. Another major cause is sports injury. Any sports can cause fall and thus lead to nasal bone fracture. Apart from fall, collision with another player while chasing for the ball in sports like cricket, football, hockey etc. can readily lead to nasal bone fracture. Accidental collision with transparent glass door has also caused nasal bone fracture. Direct punch over the nose as happen during sports like boxing, martial arts or during street fight and assaults can also fracture the nasal bones.
For diagnosis of anything, history is the first and foremost important point. Exact mode of injury coupled with detailed physical examination of the patient paves the way to proper diagnosis. In nasal bone fracture, history and inspection of the nose from different angles is equally important apart from physical examination to arrive at the diagnosis. In cases of minor deviations of nose due to fracture, comparative pre injury photographs (if available) prove valuable. X -rays are not very important to formulate the treatment plan. However, CT scan is mandatory in case of associated fractures of other facial bones and in complex injuries of nose.
Treatment of nasal bone fracture is done initially by antiinflammatory and analgesic drugs, antibiotics if required and supportive medicines. Cases in which bleeding from inside the nose or external wound has not stopped, it is of utmost priority to arrest the bleeding. Ice pack application is also advised for reduction of edema and to decrease the bruise. Decision to do surgery for nasal bone fracture is made by the surgeon after brief discussion and counseling of the patient. Surgery is usually done after 3 – 5 days of injury, when the edema (swelling) subsides substantially. Surgery for nasal bone fracture is done under general anesthesia. In most of the cases of nasal bone fracture, bones are not fixed with any screws or wires as done in other fractures. Instead, displaced and fractured bones are manipulated and placed in proper position during surgery. However, a small proportion of nasal bone fractures require open reduction and fixation of the fractures.
Cutis Hospital is a dedicated center for all sorts of trauma (including facial injury), and reconstructive and cosmetic surgeries. Nasal bone fracture is no exception to this. At Cutis Hospital, all patients with injuries are examined in emergencies by a qualified and experienced plastic surgeon. Surgery and follow-up visits are also attended by plastic surgeons. At Cutis Hospital, we treat even malunited (improperly joined) or untreated / neglected nasal bone fracture patients who present very late after the injury.
Any blunt or sharp injury when applied over the nose with moderate force, can cause nasal bone fracture. Apart from history of injury, bleeding from one or both nostrils, pain and swelling over the injured site and external deviation/deformity of nose suggest the possibility of nasal bone fracture.
You should consult a qualified plastic surgeon for a nasal bone fracture. Because plastic surgeon is trained extensively to understand and operate not only nasal bone fractures but, associated soft tissue injuries of face and fractures of other facial bones. Not only that, plastic surgeons can reconstruct lost portion of nose also.
The best time to consult a plastic surgeon is immediately or as soon as possible after the injury. In any circumstances, the consultation with your plastic surgeon must not be delayed beyond 7 days of injury, as fractured nasal bones unite very fast and this union happens in uncorrected position.
The chief cause of nasal bone fracture is direct injury over the nose. This injury can be due to vehicular accidents (bicycle, two wheeler or four wheeler accidents), sports accidents, collision with another person or objects like door and assaulted injuries as happen in street fight.
After confirmation of diagnosis, nasal bone fracture is assessed for treatment. Patient and his relatives are included in the decision making process, as all nasal bone fractures do not require operation as a treatment. Patient is offered the choice of non operative treatment whenever it is possible to treat this fracture without operation. However, operation becomes mandatory in many cases and ig is done under general anesthesia after thorough counselling.
You are allowed to have food after 6 to 8 hours of operation and discharged from the hospital on next day morning after removal of nasal pack. Nasal pack is a non adhesive pressure dressing placed deep inside both the nostrils at the time of completion of surgery, which helps in arrest of the bleeding and which held the nasal septum to midline. Apart from that, you are advised to wear a strong protective cover (nasal splint) over your nose @ 24 X 7 for 7 – 10 days. You can resume your job and routine activities after 48 hours of surgery, but not without the nasal splint.
Yes, untreated/poorly treated nasal bone fractures present to Cutis Hospital after many months or years after injury. These are the fractures which healed on their own, so position of the bones and attached soft tissues is the same as it was after the injury. These patients require comprehensive assessment of their problem which includes thorough physical examination, analysis of their facial photographs taken in standardized manner and evaluation of their CT scan. Their treatment is obviously with surgery, but it is different and difficult than conventional nasal bone fracture surgery. These patients require “corrective rhinoplasty” which is executed with utmost care and precision at Cutis Hospital.
We provide effective surgical and non-surgical treatments for all parts of the body. At Cutis Hospital, our cosmetic and plastic surgery team is committed to giving patients safe and high-quality care.
