Doctors dish on fixing Roethlisberger's nose
Steelers head trainer John Norwig stops the bleeding from Ben Roethlisberger's fractured nose Sunday in Baltimore.
Blood runs from Ben Roethlisberger's nose after taking a sack against the Ravens in the first quarter Sunday in Baltimore.
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A broken nose isn't pretty, and there's no pretty way to describe how to fix one.
So if you really care about what happened to Ben Roethlisberger's schnoz, brace yourself.
At 12:19 of the first quarter of the Steelers' Sunday night game with the Baltimore Ravens, defensive lineman Haloti Ngata swiped his huge left hand through the opening of Mr. Roethlisberger's helmet and fractured his nose.
Mr. Ngata on Monday was fined $15,000 by the NFL for the hit on Mr. Roethlisberger. The hit did not result in a penalty during the game.
From the video replay, it looks as if the blow pushed the quarterback's nose bones to the right and correspondingly displaced his septum -- the cartilage just below it -- toward the left.
Mr. Roethlisberger underwent surgery Monday, although Steelers spokesman Dave Lockett would not confirm that, saying all news would wait until coach Mike Tomlin's news conference today.
The operation was almost certainly what plastic surgeons call a "closed reduction."
In that procedure, the patient is given local anesthetic and a sedative, and the surgeon then puts an instrument called an elevator, shaped like a thick bread knife, up one of his nostrils and behind the twin bones at the top of the nose. Using the elevator as a fulcrum, the surgeon uses his gloved hand to push the nose bones back into position.
When that happens, said Randolph Capone, director of the Baltimore Center for Facial Plastic Surgery, "you feel it pop back into position, and usually it's very audible and you can hear it throughout the room."
"It's a definitive, very gratifying snap," said Dr. Capone, who wasn't sounding satisfied because he's a Ravens fan, but because it's the sign of a successful procedure.
Broken noses are common in contact sports, but because of their helmets football players are not the leading victims.
Stephen Perkins, an Indianapolis surgeon and former president of the American Academy of Facial Plastic and Reconstructive Surgery, said that broken noses are more common in soccer, field hockey, rugby, even racquetball -- any sports where unprotected faces are apt to collide with fast-moving objects.
Some of the worst nose fractures in recent years have been among youngsters playing softball, said Dr. Perkins, because of the size of the ball and the youths' slower reaction times.
When a nose is broken, doctors look for two things, Dr. Capone said -- displacement and comminution.
Displacement means the nose has been shoved to the side, backward or forward. Comminution means it has been broken into several pieces.
If the nose has a simple fracture and hasn't been displaced, he said, doctors will often leave it alone and tell the patient to let it heal.
If it has been displaced and has more serious fractures, they will do the reduction and then put an external splint on the nose for five to six days.
The splints used to be made of plaster, but today, they are composed of thermoplastic, which can be heated in a microwave to roughly the temperature of a cup of hot coffee, molded over the nose and then left to solidify and cool in about 45 seconds.
If the cartilage has been damaged, doctors will sometimes put internal silicone splints in the nostrils and suture them through the septum for several days.
Among pro athletes, basketball players will often return to action with clear plastic face guards to help redistribute any blows they receive away from the nose, but the plastic guards are not as commonly used in football.
If Mr. Roethlisberger gets an external cast this week, it will likely come off before he plays again, and he would have some tape strips over the nose at most, Dr. Capone hypothesized.
This wouldn't protect him from reinjury, of course, but, "as I tell my patients, if it doesn't work or gets reinjured, you can always have a rhinoplasty [aka, a nose job] in the offseason."
Steven Bonawitz, a reconstructive surgeon at UPMC, said he works with a couple of hockey players who periodically get into fights and who have each suffered more than one broken nose, "and I tell them we're just going to wait until their careers are over to get a rhinoplasty, because they're just going to keep getting it busted."
If Mr. Roethlisberger can avoid reinjury, the nose bones should heal in about three months, the doctors said.
First Published December 7, 2010 12:00 am