Think you broke your nose? Here’s what to do [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. What if you break your nose? Can you call a plastic surgeon and say, "I broke my nose and I don't want to go to the ER?"

Dr. O'Brien (00:10):
Oftentimes I have primary nasal fractures go to the ENTs around and have them set and they can evaluate the septum and the airway and all of those kinds of things. If they just are worried that they're swollen and is it going to look okay, but they're breathing fine and it doesn't look that different, then they can allow it to settle down and then I'll see them after a few weeks when the swelling has started to go down. But if they really have a significant fracture, I do usually refer those to an ENT.

Eva Sheie (00:42):
If you break your nose, you have time. You don't have to see a plastic surgeon urgently, right?

Dr. O'Brien (00:47):
That's right.

Eva Sheie (00:48):
So what do you need to know if you break your nose as far as cosmetic issues go?

Dr. O'Brien (00:53):
If you break your nose and you're worried about how it's going to look afterwards, which most people are, then I think the important thing is to make sure you're breathing okay and that you don't have any other injuries or what have you. And then you have time to allow things to, the swelling to go down for a few days or a week potentially. So you can call, find your provider and still have time to get it addressed within the first couple of weeks, but it's not an emergency, must be seen tonight kind of thing.

Eva Sheie (01:27):
What if you broke your nose years ago? How is rhinoplasty different if you have an ancient injury that's already been healed?

Dr. O'Brien (01:38):
The difference between repairing a nose that was just fractured and one that was fractured years ago is that a recently fractured nose, basically you can realign and splint and maybe do a few things to kind of line up the bones as they were shaped before the injury. It depends on the severity of the fracture, but in general, you can kind of line up what was already there. If it's healed and has been healed for years, it may have healed with a depression or something where now the bone is not straight as it once had been, it is actually a curved bone. And so correcting that is different. It has remodeled, it has set itself, and so you're trying to straighten a bone that is actually potentially curved, whether in or out, or one of each. And so that's where the main difference is in coming back to address it down the line.

Eva Sheie (02:36):
What other kinds of issues are resolved when you do rhinoplasty, especially on someone who's had an injury somewhere in the past?

Dr. O'Brien (02:45):
Some people come in after they've had rhinoplasty years before and have breathing issues, and it may be from a fracture of the nose, it may be from a fracture of the septum. Sometimes it's other cartilages that were actually disrupted. Again, it depends on the type of injury, but some people have had multiple injuries and so they have a number of things going on. The thing that most people who've had injuries beyond wanting it to look different is trying to improve their breathing. And the two functions of the nose are breathing, so respiration and how it looks.

Eva Sheie (03:24):
When you correct a breathing issue, is it noticeable right away after surgery that it's been resolved?

Dr. O'Brien (03:32):
Oftentimes people, when the packing comes out of their nose and everything, they really notice an incredible improvement and then the swelling kind of kicks in and so it feels a little less impressive. And then as the swelling goes down over the next weeks to months, they really can kind of settle in and see how improved the nose and their breathing is. But it is something that, depending on how obstructed the breathing was in the first place, can really be significantly improved right off the start.

Eva Sheie (04:05):
Thanks for listening. I'm your host, Eva Shie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.