Broken nose (nasal fracture)

What is a broken nose (nasal fracture)?

A broken nose is a fracture (crack or break) of the nasal bones. In most cases, there is also some damage to nearby nasal cartilage, particularly the nasal septum, the flexible partition that divides the left and right sides of the nose.

Because the nose has such a prominent and unprotected position in the center of the face, it is particularly vulnerable to impacts from accidents and violence. In mild fractures, the injury causes only some mild swelling and a brief nosebleed, so you may be unaware of the break unless your nose heals with a slight deformity.

In severe fractures, however, the nose can be obviously deformed or shifted out of its normal midline position immediately after impact. There also may be a severe nosebleed, a blocked nostril or air-flow problems related to a deviated septum (a shift of the nasal septum toward the left or right nostril).

Health care professionals do not know how often people break their noses, because many people who have mild nasal fractures do not seek treatment. Among adults and teenagers treated by doctors, the most common causes of nasal fractures include contact sports, car crashes, motorcycle accidents and violent assaults. In particular, athletes are at high risk of a broken nose if they participate in soccer, basketball, baseball, boxing, martial arts (especially kickboxing), wrestling, handball, racquetball or mountain biking.

Although the nose is also an easy target for fractures during hockey and football games, helmets used in these sports provide some protection against facial injuries. Protective helmets also may reduce the risk of broken noses (as well as more severe injuries) in people who ride motorcycles or bicycles.

The increased use of seat belts and airbags over the past three decades has dramatically reduced the number of people who break their noses by hitting the dashboard during a car crash.

In infants, the bones in the nose sometimes are fractured at the time of delivery. In older children, broken noses often are caused by a fall, a bicycle accident, contact sports or child abuse.

In general, children tend to be at lower risk of a broken nose than adults because a child's immature bones are generally less brittle and more flexible. However, a broken nose in a child is more likely to cause long-term deformities or breathing problems because a child's nasal bones and cartilage have not finished growing.

Symptoms of a broken nose

Symptoms of a broken nose include:

• Bruising, swelling and tenderness around the nose
• Nosebleed
• A deformed, twisted or crooked nose
• Blockage of one or both nostrils
• A deviated septum
• A bruise-like discoloration under the eyes.

Even if your nose is injured only mildly, the area can swell significantly within one to two hours after the impact. Until this swelling goes away, you or your doctor may not be able to accurately assess the extent of any damage.

Diagnosing a broken nose

After reviewing your symptoms, your doctor will ask how you injured your nose, whether you have broken or severely injured your nose before, and whether you have ever had nasal surgery.

Next, your doctor will examine your nose, looking at its shape and symmetry, the alignment of its bones, the position of the nasal septum and any obvious areas of deformity or tenderness. Using a bright light and an instrument (nasal speculum) that gently spreads open your nostril, your doctor will inspect the inside surface of each nostril and check your nasal septum for a bruise or blood clot. In many cases, no other tests are needed. X-rays are not always necessary.

Your doctor may refer you to an otolaryngologist (ear, nose and throat specialist) or a plastic surgeon if your nose is deformed, the air flow through your nose is obstructed, or you have other symptoms that require specialized care. These doctors may order additional testing before treating your nasal fracture.

Expected duration of a broken nose

Although tenderness and swelling usually subside within one to two weeks, any deformities of the nasal bones or cartilages are permanent unless they are treated by a specialist.

Preventing a broken nose

You can help to prevent a broken nose by avoiding trauma to your nose. Wear a seat belt and a shoulder harness whenever you ride in a car and wear headgear to protect your face during contact sports. Wear a protective helmet if you ride a motorcycle or bicycle.

Treating a broken nose

If your injured nose is deformed or misaligned and you seek emergency treatment, the doctor may attempt to realign your nose immediately. This can be done with or without surgery. For persistent bleeding, the doctor may pack the front of your nose with a hemostatic sponge or gauze. If there is a bruise or blood clot on your nasal septum (a septal hematoma), the doctor will make a small incision to allow the blood clot to drain. A septal hematoma that is not drained can lead to permanent deformity of the nose.

If your injury seems to be less severe, your doctor may wait for a few days to allow swelling to subside before assessing the situation. In many cases, the nose can be realigned within the first 10 days after injury in a nonsurgical procedure called a closed reduction. After that time, the realignment can be done surgically with a procedure called a rhinoplasty, which reshapes your nose to improve its appearance. When the nasal septum needs to be repaired as well, the procedure is called a septorhinoplasty.

When to call a professional

Call your doctor immediately if you suffer a blow to the nose and you have any of the following symptoms:

• Your nose is deformed, crooked or shifted out of its normal midline position.
• Your nasal septum deviates to the right or left.
• You have a nosebleed that lasts for more than 15 minutes.
• You notice a small, grapelike swelling on the side of your nasal septum, inside your nostril. This may be a septal hematoma.
• You have increased trouble breathing through your nose.

If you suffer a less severe blow to your nose, the initial swelling of the injury may make it difficult to see a mild nasal deformity or a deviated septum. To be sure that you have not missed a fracture, wait a few days for the swelling to subside and then check your nose in the mirror. Contact your doctor if you find that your nose is deformed, is shifted out of its normal midline position or has a deviated septum.

Prognosis

In most cases, the outlook is good, even when surgical treatment is necessary to realign or reconstruct the nose. A small number of people choose to have reconstructive surgery more than once, either for cosmetic reasons or to improve air flow.

Additional info

American Academy of Otolaryngology — Head and Neck Surgery
https://www.entnet.org/

American Association of Oral & Maxillofacial Surgeons
https://www.aaoms.org/

American Society of Plastic Surgeons
https://www.plasticsurgery.org/