John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
First, the doctor will control the nosebleed (if the patient has one). If there is a collection of blood inside
the nose, called a septal hematoma, the doctor will drain it by cutting a hole in it to let the blood out.
Because the patient's nose will be very swollen at initially, a broken nose is not immediately put back into place (reduced). Even after the swelling
improves, reducing a broken nose is necessary only if the patient will have a poor cosmetic result or airflow is obstructed. If it is necessary, a specialist will
perform the procedure at a follow-up appointment. By this time, the swelling should have
improved, and the bone should be put in place more accurately.
Fractures of the bones inside the nose (ethmoid fractures) require hospitalization.
Jaw (mandibular) fracture
A broken bone that is visible through the skin or inside the mouth, called an open fracture, requires hospital admission and IV antibiotics.
Most of the time, if a patient has a closed fracture of the jaw, he or
she will be referred to an oral surgeon for treatment.
Midface (maxillary) fracture
Because of the severity of a midface fracture and its associated injuries,
the patient may require a tube to be inserted to help them breathe, and the
patient will most likely be hospitalized.
These fractures usually require surgery. This is usually performed by a plastic surgeon or
ear, nose, and throat (ENT) specialist.
Cheekbone (zygomatic) fracture: If the patient's
zygomatic arch is fractured,
he or she may require surgery to repair it if the fracture is pushed in causing a cosmetic defect.
Eye socket (orbital) fracture
The timing of, and need for eye socket fracture repair is controversial.
Some specialists feel surgical repair is needed only if the patient has persistent double vision or
the eye recedes into the socket.
Others use CT scans to help them make the decision. The patient should decide whether to have surgery with the consulting specialist.
Temporomandibular joint dislocation: This is usually realigned in the emergency department. A local anesthetic can be used as well as medication to relax the jaw muscles.