Nasal fractures are common facial injuries frequently resulting from contact sports, physical altercations, falls, or traffic accidents. They represent the most prevalent type of facial fracture and typically present as a deviation of the nasal bridge, depression of the nasal dorsum, and impaired respiratory function. If a patient experiences difficulty breathing or significant nasal deformity, closed reduction of the nasal fracture may be indicated. 

  

Closed reduction is the most common and effective surgical approach for treating nasal fractures. The primary objective of the procedure is to realign and repair the damaged nasal bones. By restoring the normal anatomical position of the nasal bones with precision, the surgery can significantly improve nasal deformities and alleviate symptoms such as nasal obstruction. 

  

Optimal outcomes are generally achieved when closed reduction is performed within the first two weeks following the injury. However, if the injury is neglected or improperly addressed, it may result in persistent nasal deformity that can only be corrected through more invasive surgical procedures. 

  

Consequently, timely diagnosis and appropriate management of nasal fractures are essential. An evaluation by a specialist is crucial to ensure optimal surgical outcomes, thereby enhancing both the appearance and functionality of the nose. 

 

Classification and Characteristics of Nasal Fractures 

Classification	Characteristics
Simple Nasal Fracture	Involves a single nasal bone fracture without significant displacement.
Comminuted Fracture	Severe fragmentation of the nasal bone with multiple fractures and significant displacement, affecting nasal appearance and function.
Fracture of the Maxillary Frontal Process	Accompanied by a fracture of the maxillary frontal process, indicating more severe injury that may impact the overall appearance and function of the midface.
Complex Fracture	Involves nasal fractures in conjunction with other facial skeletal fractures.

 

 

Common Symptoms of Nasal Fractures 

• Nasal Pain: Patients may experience severe or persistent pain around the nose following the fracture. 
• Nasal Bleeding: Nasal fractures often result in bleeding from the nasal cavity, which can range from mild oozing to significant hemorrhage. 
• Nasal Congestion or Difficulty Breathing: Changes in the nasal cavity's structure due to the fracture may lead to congestion or difficulty in nasal airflow. 
• Nasal Swelling: Swelling of the tissues surrounding the nose is common after injury, leading to deformity or changes in appearance. 
• Periorbital Bruising: Bruising around the eyes, commonly referred to as black eyes, may occur due to ruptured blood vessels at the time of injury. 
• Facial Sensation Abnormalities: Patients may experience numbness, tingling, or a prickling sensation in the facial region following a nasal fracture. 
• Rhonchi: Patients might hear abnormal sounds or nasal wheezing after the fracture. 

 

Nasal bone fractures are among the most common facial bone fractures. It may occur when the nose impacts against a solid object (e.g. fist, forehead, dashboard, etc.). Treatment begins with evaluating the injury, taking an accurate history of the situation in which the injury occurred, and ascertaining how the face and nose appeared and functioned and before the injury occurred. 

  

Preparation 

• Fasting Instructions: Patients are generally required to fast for 6 hours before surgery, meaning no food intake for 6 hours prior to the procedure. A small amount of plain water is allowed until 2 hours before the surgery. 

• Preoperative Medications: Take any prescribed medications as instructed. 

 

Procedure 

Indications for Surgery: 

• Applicable for most simple nasal bone fractures and some comminuted fractures. 

Surgical Steps: 

• The procedure is typically performed under general anesthesia or monitored anesthesia with local anesthesia to ensure you feel no pain during the operation. 

• Access to the fracture site is obtained through a skin incision or via the nasal cavity. 

• The doctor carefully realigns the displaced nasal bones to restore them to their normal anatomical position. 

• If necessary, stabilizing devices such as nasal splints may be used to prevent the bones from displacing again. 

Duration of Surgery: 

• The surgery usually takes about 30 minutes to 1 hour. 

 

Postoperative Recovery: 

• For 1 to 2 weeks after surgery, patients need to keep the nasal area bandaged and avoid external force or impact. 

• Pain relievers can be taken to alleviate discomfort. 

• Normal activities can be gradually resumed during this period. 

 

Surgical Outcome: 

• Closed reduction of nasal fractures effectively corrects nasal deformities and improves breathing function. 

• However, a small number of patients may require a second surgery to achieve the desired results. 

 

Wound Care 

• Sit down and lean slightly forward. This helps prevent blood from flowing into the throat, avoiding choking or swallowing difficulties. 

• Use your thumb and index finger to gently pinch the soft part of your nose, just below the nostrils. Apply gentle pressure for about 10 to 15 minutes to help the blood clot. 

• Try using an ice pack or cold compress on your nose to constrict blood vessels and reduce bleeding. 

• If bleeding continues for more than 20 minutes or is excessive, it is advisable to seek professional medical assistance. 

 

Follow-up and recovery 

• Taking Pain Relievers: According to the doctor’s instructions, patients may need to take pain relievers to reduce postoperative discomfort and pain. Ensure you follow the doctor’s recommendations and dosage guidelines. 

• Monitor for Nosebleeds: Mild nosebleeds after surgery are normal, but if bleeding persists or is excessive, you should seek medical assistance at the nearest emergency room. 

• Elevate the Head While Sleeping: Elevating your head slightly while sleeping helps reduce potential swelling after surgery. You can use extra pillows or adjust the height of your mattress to achieve this. 

• Avoid Blowing the Nose: For a period after surgery, patients should avoid blowing their noses to prevent pressure on the surgical area or causing bleeding. If you need to clear your nasal passages, you can gently rinse with saline solution or use a nasal aspirator. 

 

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Reference

Rohrich, R. J., & Adams, W. P. (2000). Nasal fracture management: minimizing secondary nasal deformities. Plastic and reconstructive surgery, 106(2), 266-273.

 

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