Immediate or acute nasal fractures management can lead to long term issues.  Proper management techniques  can reduce nasal revision rate. A lower incidence of revision is attributed to complete assessment, use of outpatient controlled general anesthesia, and proper treatment of the septum in cases with severe septal fracture dislocation.

The nose and the eyes are the most prominent facial features. A fracture of the nasal pyramid is the most common facial fracture.  The increasing prevalence of this injury presents the plastic surgeon with challenging treatment options. Although nasal fractures are often discussed as minor injuries.  Traditionally these injuries have been reduced in a less than optimal manner in Emergency Rooms or in the office.  Sometimes this is done after swelling has already created a stiff skin and soft tissue envelope.  Usually the patient is told that this injury will be revised in a year.  Revision rhinoplasty for traumatic nasal deformity is a difficult procedure.a

The numerous factors that contribute to suboptimal aesthetic and functional end results include timing, edema, undetected preexisting nasal deformity, and occult septal deviation/injury. In order to improve results I recommend the immediate or acute treatment of nasal or nose fractures in an effort to correct assess and treat these injuries to improve outcomes.

Rhinoplasty ultimately changes the structure of the nose.  Anatomy is the key to understanding and performing rhinoplasty.The skin, nasal bones, upper and lower lateral cartilages externally and the septum internally are the key components in the framework of the nose.  Manipulating these structures will provide significant changes.  Whether it is done with an open or closed rhinoplasty techniques doesn't  matter. Many patients I see initially have septal issues.  The septum has three primary components.  The septal catilage, perpenicular plate of the ethmoid, and the vomer.  There can be a number of reasons for septal problems which nclude but are not limited to nonspecific deviation, deviation to trauma with or without fracture of the boney or cartilaginous septum.  Correction of these deformities can be done using open or closed rhioplasty techniques.  Once access has been gained to the septume and mucoperichondrium has been elevated the defect is evaluated.  The deviation is usually corrected through removal of the septal cartilage and bone.  A certain amount of cartilage is maintained to provide support in the form of an L - Strut.  Cartilage can then be used to provide more structural support in the form of spreader grafts or a columellar strut.  At this point the reconstruction of the septum is relatively complete.  I will contune to blog about nose surgery in the future.