From the Research
Emergent surgery is not typically needed for a displaced bilateral nasal septum fracture, and instead, a delayed surgical approach called septoplasty is usually recommended, ideally performed within 7-10 days after the injury once the initial swelling has subsided. This approach is supported by the most recent and highest quality study available, which suggests that immediate septoplasty in the case of associated septal fractures significantly decreases the rate of postoperative complications 1. In the acute phase, management focuses on controlling symptoms with:
- Nasal decongestants like oxymetazoline (2-3 sprays each nostril twice daily for no more than 3 days to avoid rebound congestion)
- Oral analgesics such as acetaminophen or ibuprofen for pain
- Ice packs applied to the nose for 15-20 minutes every 1-2 hours for the first 48 hours to reduce swelling If there is significant nasal obstruction causing breathing difficulties, temporary nasal packing or splinting may be required. The decision for surgical correction depends on both functional issues (breathing difficulties) and cosmetic concerns. Surgery allows for proper realignment of the septum to restore normal nasal airflow and facial appearance. While waiting for definitive treatment, it is essential to avoid activities that could cause additional trauma to the nose and sleep with your head elevated to help reduce swelling. Additionally, the use of antibiotic prophylaxis is not routinely recommended for septoplasty, as the infection rate after elective nasal surgery is very low, making routine antibiotic prophylaxis redundant 2, 3. However, the most recent study suggests that patients treated by closed nasal reduction + closed septoplasty had the best postoperative evolution, and immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications 1.