Assessment and Timely Management
Nasal fractures are the most common facial fracture and typically occur following trauma such as sports injury, falls, or accidents.
Early assessment and timely treatment are important to restore both the function and appearance of the nose.
Management is usually straightforward if addressed promptly, but delays can make correction more complex.
Elite Sport and Return to Play
Dr Tom Pepper understands that facial trauma in athletes requires a different approach to standard care. Alongside accurate reconstruction, there is a need to:
- Minimise time away from sport
- Protect the injury during recovery
- Restore functional performance as early as possible
Drawing on his experience treating high-level athletes in the USA, surgical care is structured to minimise downtime while preserving long-term function.
This includes rapid intervention where required, an accelerated return-to-play strategy, and the use of custom-fitted facial protective equipment to enable earlier reintroduction to training while reducing the risk of re-injury.
How Nasal Fractures Present
A nasal fracture may result in:
- Pain and tenderness
- Swelling and bruising around the nose and eyes
- Visible deformity or deviation
- Nasal blockage or difficulty breathing
- Bleeding from the nose
Initial swelling can mask the true shape of the nose, so reassessment after a few days is often important.
Assessment
Assessment includes:
- Clinical examination of nasal alignment
- Evaluation of airway function
- Exclusion of associated facial injuries
Imaging is not always required unless more complex injury is suspected.
Timing of Treatment
Closed reduction of a nasal fracture is time-dependent.
- Ideally performed once swelling has reduced (usually at leats 5 days)
- Should usually be completed within 21 days of injury in adults before the bone begins to heal in the displaced position
Beyond this window, manipulation becomes less effective and may not achieve a satisfactory result.
Closed Reduction Under General Anaesthetic
Most displaced nasal fractures are treated with closed reduction under general anaesthetic.
- The nasal bones are repositioned without external incisions
- The procedure is relatively quick
- Nasal alignment is restored as accurately as possible
This approach avoids open surgery while addressing both cosmetic deformity and airway obstruction.
After the Procedure
Internal Nasal Support
- Soft internal packs (e.g. Nasopore® or Merocel®) may be placed
- These support the nasal framework during early healing
- They are usually removed or dissolve within a few days depending on type
External Splint
- A nasal splint is applied externally
- Typically worn for 7–10 days
- Helps maintain alignment during early healing
Bruising and Swelling
- Bruising around the eyes is common and settles over 1–2 weeks
- Swelling of the nose improves gradually over several weeks
- Final refinement of shape may take longer
Recovery
- Most patients return to normal daily activity within a short period
- Contact sports and further trauma should be avoided for several weeks
- Breathing usually improves once swelling settles
Follow-up ensures that alignment and function are satisfactory.
Outcomes
Closed reduction is effective in many cases, particularly when performed within the correct time window.
However:
- Perfect restoration of pre-injury appearance cannot always be guaranteed
- Minor asymmetry or irregularity may persist
The goal is timely correction with the least invasive approach.
If the Treatment Window Is Missed
If treatment is delayed beyond the optimal window:
- The bones can heal in a displaced position
- Closed reduction becomes less effective
In these cases, persistent deformity or breathing problems may require:
Secondary Rhinoplasty or Septorhinoplasty
- Performed at a later stage once healing is complete
- Allows formal correction of both structure and appearance
- More involved than initial closed reduction
Likelihood of Secondary Surgery
While many patients are satisfied following closed reduction, a proportion will go on to require further treatment.
- Reported rates of secondary rhinoplasty vary, typically in the region of 10–30%
- Higher rates are seen in more severe injuries or where initial deformity is significant
This reflects the limitations of closed reduction, particularly in complex fractures.
Risks and Considerations
Potential risks include:
- Residual deformity
- Persistent nasal obstruction
- Need for further surgery
- Bleeding or infection (uncommon)
Careful technique and appropriate timing are key in achieving the best outcome.
When to Seek Assessment
You should seek assessment if you have:
- A suspected nasal fracture
- Visible deformity
- Ongoing nasal obstruction
- Persistent swelling or asymmetry
Early evaluation allows for simpler and more effective treatment.
Consultation
A consultation allows assessment of the injury, discussion of timing, and planning of appropriate management.
Book a Consultation
For assessment and management of nasal fractures in London, arrange a consultation to discuss your options.