Q. My son just broke his nose for the fourth time. We went to the emergency room, waited three to four hours, got an X-ray, then we were told that they couldn’t do anything and that I would need to see a facial plastic or plastic surgeon to fix it. There must be a better way! Can you tell me?
A. Of course there is. In more than 30 years of treating patients, the one X-ray that I find that is the most useless is the nasal bone X-ray. I rarely find that I will change my clinical plan based on the X-ray alone. My suggestion is the next time your son breaks his nose, and as long as he's not actively bleeding, I would go home and put ice on it and see your facial plastic or plastic surgeon the next day.
It is important that someone looks at your son’s condition to make sure that he does not have a septal hematoma(blood clot). If he does, it is important that it be drained early so that it does not get infected and cause a nasal collapse. Since by this time you probably already have a physician that you trust, just ask him or her how best to reach them. Ask them what they would like you to do when your son breaks his nose (it will happen again).
Very often there is nothing to do for a non-displaced fracture. If, however, your son's nose is crooked it is imperative that you try the “easy” approach to repairing it. The easy approach is a closed reduction with some sedation of the fracture. This is done in a 20-minute operation that essentially re-creates the break so that the nose is straightened. By doing this within the first seven days you may save your son a major nasal reconstructive surgery. If, however, the septum is involved and it’s more complicated, you should wait six to eight weeks to do a complete rhinoplasty repair when all the inflammation is gone.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at Cwolf@miamiplasticsurgery.com.