10 Tips on Nasal Fractures (Broken Noses) in Children
Thursday, January 14. 2010 posted in Rhinoplasty
It is surprising that there aren't more fractured noses given the number of times our noses are traumatized, especially our active children. The most common question and cause for concern after nasal trauma is, "Doc, is the nose broken?" Here are 10 tips on broken or fractured noses :
1. Don't panic. All bleeding eventually stops. Apply pressure with your fingers to the upper 1/3 of the nose, and hold a little pressure on the nostrils while squeezing them, holding a few Kleenex under the nostrils.
2. Put some ice on the bridge of the nose, and avoid blowing the nose.
3. It is seldom necessary to rush into surgery to correct the nasal fracture, as it is best to wait at least 5 days for the swelling to resolve, especially in children. Unfortunately, unsuspecting parents may be exposed to an unethical surgeon who will immediately operate on the child's nose even before the swelling has resolved. Many of these children do not need surgery, and are exposed to the unnecessary risks of anesthesia and surgical complications such as severe hemorrhage.
4. The nose should be checked by a facial plastic or ENT (ear, nose, throat) surgeon within 12 to 24 hours of the injury to make sure that there is not internal nasal septal bleeding (a septal hematoma, a very rare condition that is the only reason for immediate surgery). The child should then return for re-examination 5 days later.
5. Apply "baggies" of frozen peas to the bridge of the nose during the first 48 hours after the trauma. The cold packs can be kept on for 10 to 15 minutes and then off for 10 to 15 minutes.
6. Have your child keep his/her nose above the level of their heart when lying down, and when sleeping (sleep up on 2-3 pillows). This will help keep the swelling down, as well as help with breathing.
7. X-rays of the nose usually don't mean a thing other than for insurance companies and medical-legal reasons. Once the swelling has resolved, the nose will either be visibly crooked or not. The decision to treat the nose is made by clinical examination. If the bones feel and look straight, surgery is not necessary. I have seen fractures where the X-ray showed broken bones, but the nose was straight. These noses heal well by themselves. On the other hand, there have been noses where the X-ray appeared normal, but the nose was quite crooked.
8. The only surgery that should be performed on a child's crooked, recently fractured nose is a "closed" nasal reduction which involves manipulating the nose with an instrument inside the nostril. No incisions need to be made. The closed reduction should be performed between 5 to 14 days after the injury. By 18 days, the nasal bones may have healed and are difficult to shift back.
9. If "open" surgical correction is necessary, it should be delayed at least 6 months to allow for full healing from the trauma. It should also be delayed until your child is past puberty, and their growth has slowed down. If they have a deviated septum with difficulty breathing, sometimes the surgery can be performed earlier.
10. When in doubt, always get a second opinion, and choose your physician carefully. Be well!
1. Don't panic. All bleeding eventually stops. Apply pressure with your fingers to the upper 1/3 of the nose, and hold a little pressure on the nostrils while squeezing them, holding a few Kleenex under the nostrils.
2. Put some ice on the bridge of the nose, and avoid blowing the nose.
3. It is seldom necessary to rush into surgery to correct the nasal fracture, as it is best to wait at least 5 days for the swelling to resolve, especially in children. Unfortunately, unsuspecting parents may be exposed to an unethical surgeon who will immediately operate on the child's nose even before the swelling has resolved. Many of these children do not need surgery, and are exposed to the unnecessary risks of anesthesia and surgical complications such as severe hemorrhage.
4. The nose should be checked by a facial plastic or ENT (ear, nose, throat) surgeon within 12 to 24 hours of the injury to make sure that there is not internal nasal septal bleeding (a septal hematoma, a very rare condition that is the only reason for immediate surgery). The child should then return for re-examination 5 days later.
5. Apply "baggies" of frozen peas to the bridge of the nose during the first 48 hours after the trauma. The cold packs can be kept on for 10 to 15 minutes and then off for 10 to 15 minutes.
6. Have your child keep his/her nose above the level of their heart when lying down, and when sleeping (sleep up on 2-3 pillows). This will help keep the swelling down, as well as help with breathing.
7. X-rays of the nose usually don't mean a thing other than for insurance companies and medical-legal reasons. Once the swelling has resolved, the nose will either be visibly crooked or not. The decision to treat the nose is made by clinical examination. If the bones feel and look straight, surgery is not necessary. I have seen fractures where the X-ray showed broken bones, but the nose was straight. These noses heal well by themselves. On the other hand, there have been noses where the X-ray appeared normal, but the nose was quite crooked.
8. The only surgery that should be performed on a child's crooked, recently fractured nose is a "closed" nasal reduction which involves manipulating the nose with an instrument inside the nostril. No incisions need to be made. The closed reduction should be performed between 5 to 14 days after the injury. By 18 days, the nasal bones may have healed and are difficult to shift back.
9. If "open" surgical correction is necessary, it should be delayed at least 6 months to allow for full healing from the trauma. It should also be delayed until your child is past puberty, and their growth has slowed down. If they have a deviated septum with difficulty breathing, sometimes the surgery can be performed earlier.
10. When in doubt, always get a second opinion, and choose your physician carefully. Be well!
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