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Facial fractures require appropriate initial management. If the initial treatment was not optimal, or if the complex fracture(s) could not be completely reduced, the sequelae may be addressed surgically at a later stage.
Fractured nose:
The nasal bones are the most frequently fractured. A nasal fracture only requires treatment if it is displaced. In that case, there are 8 to 10 days to perform the reduction surgery. Signs of a nasal fracture include a "spectacle-like" hematoma, swelling, and nosebleeds. Treatment is only urgent in the case of a hematoma of the nasal septum: this hematoma must be drained to avoid the risk of cartilage melting of the septum and a "boxer's nose." These septal hematomas are rare. Most of the time, only the nasal pyramid is fractured. An ENT specialist should be consulted after 2 to 3 days, once the swelling has decreased somewhat, to assess for displacement.
- If the fracture is displaced, it is best to reduce it. The procedure is usually performed under general anesthesia (although it is theoretically possible under local anesthesia) during a one-day outpatient procedure. It consists of repositioning the nasal bones and maintaining this reduction with one or two gauze packings in the nasal cavity(ies) and a splint.
- The wick(s) will be left in place for 2 to 3 days and the splint for 7 to 8 days.
It is possible that a displacement may persist despite the reduction, or that the bone healing may result in a callus causing a nasal hump. It is also possible that an associated fracture of the nasal septum may cause a troublesome nasal obstruction affecting breathing. If such cosmetic or functional sequelae persist one year after the trauma, rhinoplasty (correction of the appearance of the nasal pyramid) or septoplasty (rhinoplasty combined with correction of a deviated septum) may be considered (link to rhinoplasty tab).
