Thank you for your consult at DoctorSpring.com.
According to your history you had a nose job done in 2010. However, you have not mentioned whether it was a reduction or augmentation rhinoplasty (whether the nose was over sized or under sized for which you had the nose job done). Also, you did not mention whether you had osteotomies (breaking the bones at the sides of the nose to reshape the same). If osteotomies had been done then the bones are fractured and the fracture lines reshape in the new position.
Next, you have mentioned that you received a knock in the nose around a year following the procedure and X-rays did not show any fracture but you were in pain for months. A nasal fracture can be sometimes difficult to elucidate with conventional X-rays and further analysis is usually mandated if the pain is severe. Anyway, missed fractures can result in quite a bit of reshaping of your facial architecture which occurs quite silently.
Now, you require a tooth extraction in the region where your nose got the knock around 2 years back since you have been using braces. Given your scenario, I feel that it is extremely unlikely that the tooth extraction and the shape of the teeth in the front has any relationship to the knock which you received about 2 years back.
Based on your question, you can now safely go ahead with the tooth extraction and further management with braces as your dentist feels necessary. There is no reason to wait.
Hope this helps, Please let me know if you need further clarifications. Wish you all the very best.
Dr. Souvik Adhikari, MBBS, MS, MCh (Plastic Surgery)
Assistant Professor of Plastic Surgery
Institute of Post Graduate Medical Education & Research, Kolkata.
Consultant Aesthetic, Plastic & Reconstructive Surgeon.
Patient replied :
Dear Dr. Souvik Adhikari,
my nose was oversized, a bit crooked and had a bump. So the whole nose was basically changed; the sides were made thinner, the bump got removed and the tip was shaped rounder.
On the outside I am really happy with the results but on the inside it was extremely painful and frustrating after the knock.
I could also feel a small crack on my forehead, near my skull, but my doctor said it is nothing serious.
Currently yes, I need a tooth extraction and I am considering braces on the front teeth only, as I feel that the changes to my teeth are due to the knock and the self-healing process of my nose.
But as I said, maybe I am just paranoid. However, I am happy and more comfortable now that I got an answer. Thank you!
I absolutely understand your concern. However, please note that it would take a MAJOR fracture to your maxilla so as to make some really noticeable changes in your teeth alignment therefore it should have been clearly evident in a X-ray. What I was talking about was a subclinical fracture which does not effect such a drastic change.
Therefore, you can safely go ahead with the extraction! If you encounter any problems at any point of time you are welcome to get back to me.
Patient replied :
Dear Dr Souvik Adhikari,
I have a last question: If let's say there would have been a major fracture, what could have been done? My doctor basically told me that even though if my nose would be broken, there is not much to do about it other than pain killers. I do not really trust my own doctor, though, and I am strongly considering changing doctor.
Had there been a major fracture then it needed reduction and bone apposition and fixation using miniplates. Pain killers are only supplementary.