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Early Correction for Traumatic Nasal Deviation

Homepage Star of March 2015
[ Author:Fushun Ma | Time:2015-07-26 19:16:52 |  Font Size: [Large Medium Small]
Tags: nasal deviation, nasal injury, traumatic deviation, correction surgery

The bony nose is compose of the nasal bone and the process of the maxillary bone. Both of them are very thin, so the bony nose tend to be brake under injury force. The form nasal deformity caused by injury could be various depending on the direction and energy of the causing impact, including deviation deformity that means the bony nose twisted to one side or another and saddle deformity which means the bony part of the nose is compressed to become flat. The correction surgery is relatively simple in early stage after injury than late stage except in some special conditions such as tissue lose or comminuted fracture. The correction surgery could be as simple as fracture reduction and fixation. However if the opportunity of early stage correction is missed, the fractured bone pieces are then reunion in misplaced position. In this instance the correction surgery has to include nasal bone osteotomy, beside reduction and fixation, much more complex than operation in the early state.

The girl in this page came to see me at one month after injury. The causing impact come from her right front direction. Her bony nose was obviously twisted to the left side. She wanted to do surgery to correct the deformity. As the injury happened only a month ago and CT confirmed the fracture lines were still not firmly reunion her correction surgery belonged to the category of early stage. Then fracture reduction procedures of the dislocated nasal bone, the process of the maxillary bone and the bony nasal septum were performed under local anesthesia. Her surgery went well and a plaster cast external fixation was applied for one week. The girl is satisfied with the surgery and her nose is believed to be fully recovered to her pre-injury condition.

 early correction surgery for nasal bone injury
The nose is fully recovered to the pre-injury condition after early correction surgery for traumatic nasal bone deformity.

early correction for nasal bone fracture
The middle line of the nose depicts the nasal bone deviation. After surgery the nasal deviation is corrected and the middle line go back to a straight line(the right side photo).

The impact force came from the right front direction fractured the nasal bone and pushed the bony nose deviated to the left side. However the soft part of the nose, which is the tip of the nose kept in its normal position. These changes eventually twisted the nose into a reversed "C" shape. The middle line of the nose was not straight any more, instead angled at the middle and lower portion of the nose. After surgical correction the middle line went back to straight.

Beside the middle line switch the impact force also caused the indentation on right side of the bony nose which in turn narrowed the nose. These changes plus the nasal septum shift blocked the air way of the nose and also interfered the function of smelling. After surgery the indentation was corrected and the septal deviation was also modified surgically. The air way and olfactory functions of the nose restored.

deformity correction after nasal injury
The nasal bone indentation and mid-line twist are shown in this angle of view.

plastic surgery after nasal bone injury
In profile view the nasal bridge is straight in the after surgery photo.

plastic surgery after nasal fracture
In chin down position the nose is small and twisted (left side photo). After the correction surgery these abnormalities disappeared.

After injury the nose of this girl looks disfigured in the photos no matter in which angle of view, which including the size change and the middle line twist. If no correction surgery was done her nose would kept disfigured. And if the surgery wasn't done in the early stage before the displaced nasal bone firmly reunited the surgeries should then include osteotomy of the nasal bone before any reduction procedure. So for traumatic nasal bone deformity correction doing the surgery in early stage is much more easier and effective than in late stage.

The recovery time after fracture vary in deferent individuals. In general within 10 weeks after injury the bony eschar has not formed at the fracture site and the union of the fractured bones are not firm. Correction surgery within this period can be as easy as bone reduction and fixation, no osteotomy is needed. And the shape and function of the injured bone have more chances to be fully recovered after correction surgery.

On the other hand if the optimal early correction stage is missed a late stage correction is more complex but also is recommended as the nose is very important for the facial figure. The bones that form the bony nose are flat bone. They are thin and tiny. Once the displaced fracture bone is firmly reunion the  osteotomy procedure for the tiny flat bone is quite challenge than for the long bone. Surgical damage to these bone can easily happens, it may make the tiny bones ever tinier eventually jeopardize the final correction result. Experienced surgeons can locate the osteotomy site precisely under CT guidance and effectively protect the nasal bone. So a good cosmetic result can still be achieved in their hands even the correction surgery is in the late stage.

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