Suffering from a broken nose can be a frightening experience. You may have had a bad nose bleed, developed disfigurement of your nose, and now have difficulty breathing. The septum may have also been fractured leading to a deviated septum. A nasal fracture may occur from a motor vehicle accident, sporting injury, or assault. Any of these mechanisms of injury can cause a broken nose. The nasal valve may have also been compromised or collapsed leading to further nasal airway obstruction and difficulty breathing through the nose.
Management of a nasal fracture is divided into three stages. The initial management is to control any nose bleed and repair any external lacerations. This is typically done in the emergency room with most patients. The next step is to wait 3-5 days to allow the swelling to subside both on the outside and inside of the nose. At this point, you and Dr Funk can evaluate whether there is a significant fracture leading to a cosmetic deformity. In addition, you can assess whether you are having difficulty breathing through your nose.
A severe enough nasal bone fracture can lead to a crooked nose, a canted nose, or a deviated nose. This can lead to a distraction of the face to one's nose and lack of attention to features such as the eyes, lips, and hair.
If there is a change in the appearance of your nose or you can't breathe through the nose, the next stage involves reducing the fracture. This is typically done in the operating room but can be done in the office under local anesthesia depending on patient comfort. This minor procedure involves moving the bones back into place to improve the cosmetic appearance of the nose after the nasal fracture. The nose will be significantly straighter after this procedure, but may still not be exactly as it was prior to the injury. Moving the nasal bones may or may not also help your breathing through your nose.
The third stage, if necessary, is done 3-6 months after the second stage. This is a more definitive operation that will straighten the nasal bones even more and improve breathing significantly. In those patients who had improvement after the second stage but still feel their nose is a little crooked or are still having issues with breathing, they are good candidates for the third stage which is a functional rhinoplasty. Here the bones are rebroken and placed into the appropriate position. In addition, a septoplasty is performed to fix a deviated septum and typically spreader grafts are placed in the nasal valve to open the airway more and make the nose straighter. This is a more extensive procedure than stage two, but is the definitive treatment after severe nasal trauma.
Zygomatic Malar Complex (ZMC) Fracture (Cheek)
A zygomaticomalar complex fracture is also know as a trimalar fracture. This is a complex fracture that involves the cheek, zygomatic arch, and the orbit. A ZMC fracture may occur from a motor vehicle accident, assault, or sporting related incident. Patients with a ZMC fracture may have a depressed cheek, numbness of the fractured cheek and upper teeth, and a bite that feels off. Trouble and difficulty opening the mouth can also occur after a cheek fracture.
Evalutation of a ZMC fracture begins with a thorough exam of the eye, cheek, and mouth. A CT scan or CAT scan is essential to evaluation of a ZMC fracture. This allows adequate visualization of the fractures and helps with surgical decision making.
Surgery for a fracture of the cheek entails general anesthesia. An incision is typically made under the lip on the fractured side. Additional incisions may also be necessary such as in the scalp temple area, or just above the eye close to the eyebrow. Once the fractures are exposed, the bones are brought back together like the pieces of a puzzle. Small plates are placed across the ZMC fractures and screwed in position to hold the bones in place.
Typically patients require 2 weeks for recovery after repair of a ZMC fracture.
Orbital Blowout Fracture (Eye Area)
Fractures of the orbit or fractures of the bone surrounding the eye can occur from motor vehicle accidents, sporting incidents, or assault. Orbital fractures and orbital blowout fractures may be associated with nasal fractures and ZMC fractures. Patients may develop blurred vision or double vision after an orbital fracture or orbital blowout fracture. Double vision when looking up may be the only symptom or double vision at all times may occur. The eyeball or globe may seem asymmetric compared to the the other globe and appear depressed or sunken in. These are all symptoms of orbital fractures depending on the severity of the fracture.
Repair of an orbital fracture or orbital blowout fracture is done in the operating room. The key is to lift the globe and surrounding fat out of the fracture to prevent the eyeball from falling more and correct any double vision. This is done with an incision just under the lower lash line or through the conjunctiva - the inside pink portion of the eyelid. The fracture is identified and the globe, fat and surrounding muscles are lifted up and out of the fracture. A small titanium plate is then placed over the fracture to support the eyeball and surrounding tissues.
Another method and approach to an orbital fracture or orbital floor fracture is to make an incision under the upper lip and enter into the sinus. The orbital floor is then approached through the maxilllary sinus from below. The orbital contents as described are placed back up through the fracture and then a small piece of bone or plate is placed to hold these contents in place. This is all done endoscopically with the use of cameras and small incisions from below.