See how to reset a nasal fracture using a closed reduction technique
Dr. Lamperti shows how he fixes a broken nose with a closed nasal fracture reduction procedure. He then goes on to show you how the nasal cast is applied at the end of the procedure.
"This is Seattle Facial Plastic Surgeon, Dr. Thomas Lamperti. Today I'm going to show you how to reset a broken nose. Our patient has a depressed nasal bone fracture on his left side. You can see where my index finger is pressed -- that is where the nasal bone is depressed inward. I'm using what's called a Boise elevator. It's just a blunt instrument that we insert inside the nostril on that side. I'm pressing outward and using my other hand to palpate and figure out where I want the bone and mobilize and reset the position of the bone. Often the bone will lock into place and that's how we can tell when the bone is back where we want it.
Once I'm happy with the position of the bone I now make the external cast. This is the same type of dressing that I use if I have done nasal bone fractures during a rhinoplasty. I'm placing some skin adhesive followed by a telfa non-stick dressing. We'll now place steri-strip tape on top of the telfa dressing and the skin. This helps maintain the bone where we want it and also helps with maintaining decreased skin swelling. Once we've completed placing the steri-strip tape we'll now cut the aquaplast (or thermosplint) . It comes in a sheet in this case and I'm just going to customize it by cutting out the pattern that I want. Once I have the shape that I desire we'll place it against the patient's nose and make sure it is the proper size and length. And next we'll place it in some hot water. This will activate the thermoplastic capabilities of the material and softens and makes the cast flexible. You can see that next we're dipping it in the hot water and it just takes a few seconds and it softens and it becomes clear. It starts off as white. Pretty quickly you can see how it is flexible. Now this allows us to mold it around the nose. The cast essentially acts like a helmet or protective cover for the nose. It is on for a week then we remove it in the office after about a week along with the tape. The bones themselves don't fully heal or set for about 5 more weeks after that. It takes about 6 weeks for the bones to reset fully. But during the first week when it is most prone to additional trauma we do leave this cast on. And this is the end of the procedure. You can see that the nasal cast placement actually takes longer than the nasal bone resetting itself. This isn't uncommon, but it is an important step to protect the work we've done."