Reduction (replacing the bones in a normal anatomic position) of a fractured (broken) nose should be done within the first 24 hours even in the presence of edema, unless massive. The defect noted on clinical exam is more important than the severity noted on the radiographs (X-ray). Generally, the reduction can be done under local anesthesia, except in noncooperative children.
Steps In the Procedure (to repair depression of left nasal bone with lateral displacement of the right nasal bone).
1. A test dose of 10% cocaine should be given to the patient by placing a small amount on the oral mucosa using a cotton swab.
2. A period of 5-10 minutes is allowed to lapse with careful hemodynamic monitoring.
3. Two cotton tampons soaked in 4 mls of 10% cocaine or 4 percent lidocaine and Afrin (oxymetazoline) for vasoconstriction are inserted into each nares end-to-end for 10-15 minutes.
4. If there is significant edema, the superior or deep tampons are then advanced further into the nares for an additional five minutes.
5. 1% lidocaine (Xylocaine) is injected at the base of the infraorbital nerve where it traverses the foramen and at the base of the columella and glabella.
6. 1% lidocaine is injected to provide topical anesthesia to anterior ethmoid nerves using an intranasal (inside the nose) technique.
7. A long, thin periosteal elevator is inserted into the left naris (nostril) to the superior edge of the noticeable deformity and is positioned so that the flat, broad surface is next to the nasal septum and the narrow edge is facing toward the surgeon.
8. When placing the periosteal elevator, care must be taken to avoid injuring the cribiform plate of the ethmoid bone.
9. Pressure is placed with the surgeons fingers on the laterally displaced right nasal bone.
10. The perosteal elevator is then used to “lift” the depressed nasal bone back into anatomic position by moving the elevator upward and laterally.
11. Pressure on the elevator is stopped when a clicking noise has been appreciated.
12. The periosteal elevator is removed and the nasal septum is examined.
13. If the nasal septum is fractured, the nares is packed with antibiotic coated gauze or Teflon splints are sutured into place.
14. External splints maybe be used to reduce pain and the liklihood of impaction.