Reposition of nose bones

A nasal fracture is the most common injury to the facial skeleton, accounting for 40-50% of all facial fractures. To restore the correct alignment of the nasal structures in fractures, the nasal bones are repositioned. EMC clinic doctors perform surgery in an open or closed manner according to the most modern medical protocols.

Types of nasal bone fractures

The external nose is a pyramidal-shaped organ formed by bone and cartilaginous structures. The bony skeleton consists of the nasal bones proper, as well as the processes of other bones (frontal, upper jaw). In the lower part, the nasal skeleton is formed by cartilages: triangular lateral cartilages, nasal wing cartilages and sesamoid cartilages. The osseous-cartilaginous arch of the nose is supported by the nasal septum, which consists of a coulter, a process of the latticed bone and a quadrangular cartilage. The bone-cartilaginous structures of the nose are quite fragile and vulnerable to shock.

In Russian diagnostics, all fractures of the nasal bones are divided into closed and open. Closed fractures include fractures that preserve the integrity of the skin. With open fractures, in addition to bone damage, a wound to the skin and soft tissues of the face occurs.

There are five types of nasal fractures in the Western classification:

1. Simple without displacement (the nasal bone does not deviate from the central line).
2. Simple with a curvature (unilateral or bilateral, the nasal bone deviates from the central line).
3. Fracture with fragmentation (fragments are formed).
4. Fractures with significant displacement and deformation of the nose.
5. Combined wounds are injuries in which soft tissue lacerations, open lesions, deformity and displacement of bones are formed.

In addition, nasal fractures are divided into isolated and combined. In the first case, injury usually occurs with low-energy exposure. With a strong impact, a fracture of the bones of the nose is usually combined with injuries to other tissues or bones of the face — such a pathology is called combined.

Types of nasal bone reposition

Nasal bone reposition is the restoration of an anatomically correct organ shape after injury. The methods of reposition depend on the time that has passed since the fracture:

• The acute stage. This period lasts up to two weeks after the injury, but it is recommended to reposition the bones within the first 24 hours, as it is easier to correctly match the fragments at this time. After that, swelling of the tissues begins to increase, which makes it difficult to reliably assess the restoration of the shape of the nose after reposition, and a callus begins to form, which collapses during reposition, so restoration and proper fusion of anatomical structures will take a longer time. In addition, there is a risk of improper fusion, which will lead to cosmetic defects and impaired function. The reposition in the acute period is carried out according to the standard method: finger-instrumental reposition of the bones of the nose.

• An old fracture. If the patient does not see a doctor until 1.5 months after the injury, the bone tissue does not heal properly, and the nasal septum often deforms. In this case, the reposition is performed simultaneously with the surgical correction of the septum.

• Permanent deformation. During this period, the splicing process is finally completed. The reposition is performed only surgically using osteotomy — the surgeon has to perform incisions on the bones in order to shift the bone tissue in the right direction.

According to the existing defect and its stage, the method of reposition is chosen.

Simple reposition

This method is used for closed fractures without significant curvature. A simple reposition is applicable in the first days after an injury. If the fracture is accompanied by hematomas, significant bleeding and swelling of soft tissues, the operation is performed on day 4-5, after the swelling subsides slightly. During this period, the patient is recommended to apply cold and use other means to reduce edema. The procedure is usually performed under local anesthesia, but sedation or short-term general anesthesia may be used at the request of the patient or on the recommendation of a doctor. During the operation, the doctor uses instruments and fingers inserted into the patient's nasal passage to return the damaged structures to the anatomically correct position by applying pressure to them in the opposite direction of displacement. If necessary, the nasal septum is straightened using special forceps.

Open repository

Such an operation is performed through an incision or wound of soft tissues, which is expanded if necessary. Open-ended repositioning is performed for complicated fractures of the nasal bones: the formation of sharp fragments that damage soft tissues and skin, the inability to reconstruct without surgery, severe combined injuries to facial structures (frontal sinus, zygomatic bone, etc .).

With such an operation, general anesthesia is indicated. The doctor adjusts and connects the fragments, if necessary, fixes them to each other. In some cases, autografts from the patient's own cartilage or bone tissue (for example, from rib cartilage or temporal fascia) have to be used to restore the shape of the nose. After the reposition is completed, a cosmetic seam is applied.

After surgery, tissue immobilization is performed for faster and more successful healing: the nasal septum is stabilized in the correct position with tampons or splints, and a special splint is applied to the outer surface. Sometimes the patient has to wear a plaster cast for two weeks before the initial fusion of the hard tissues.

If it was not possible to perform the reposition in the early period, the operation is postponed for several months until the tissues are completely healed. In the future, the patient will be able to undergo cosmetic surgery to correct the shape of the nose — rhinoseptoplasty.

Frequently asked questions

Which doctor performs the nasal bone reposition?

The reconstruction of the bone and cartilaginous part of the nose is performed by a maxillofacial surgeon or an ENT surgeon.

What happens if you don't fix your nose after a fracture?

After a fracture, the nose can change shape and proportions, which creates cosmetic problems. In addition, post-traumatic changes in bone and cartilage structures make nasal breathing difficult, provoke nighttime snoring, and cause hypoxia — oxygen deficiency. In some cases, the nasal passages are completely blocked. Constant breathing through the mouth increases the susceptibility to infections, contributes to frequent acute respiratory viral infections. If the nose is not fixed immediately after the fracture, a complex multi-stage operation may subsequently be required to eliminate cosmetic and functional defects.

How long does the nose heal after repositioning?

The initial bone healing after surgery takes about two weeks. However, the final recovery may take up to two months.