Broken nose

A broken nose, also called a nasal fracture can affect both bone and cartilage (see Figures 1 to 4). A collection of blood (called a “septal hematoma”) can sometimes form on the nasal septum (a wall made of bone and cartilage inside the nose that separates the sides of the nose) (see Figure 3). However, the term “broken nose,” in most cases, refers to damage to the septal cartilage rather than the nasal bones themselves.

Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in facial trauma. A broken nose can cause pain, along with swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing.

Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn’t necessary for a broken nose.

A broken nose usually heals on its own within 3 weeks. Get medical help if it’s not getting better or your nose has changed shape.

Broken nose complications

Complications or injuries related to a broken nose may include:

• Deviated septum. A nose fracture may cause a deviated septum, a condition that occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced, narrowing your nasal passage. Medications, such as decongestants and antihistamines, can help you manage a deviated septum, but surgery is required to correct the condition.
• Collection of blood. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils. Septal hematoma requires prompt surgical drainage to prevent cartilage damage.
• Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you also may experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgeon should address both your bone and cartilage injuries.
• Neck injury. Likewise, nose fractures resulting from high-velocity injuries — like those experienced in motor vehicle accidents — may be accompanied by injuries to your neck. If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck. If you suspect a neck injury, see your doctor immediately.

The nose

• Provides an airway for respiration.
• Moistens and warms entering air.
• Filters inhaled air to cleanse it of foreign particles.

The paired nasal bones are small, flattened, rectangular-shaped bones that form the bridge of the nose (see Figures 1 and 2). These small bones protect the upper entry to the nasal cavity and provide attachment for a couple of thin muscles of facial expression. For those of you who wear glasses, they are the bones that form the resting place for the bridge of the glasses. The major structural portion of the nose consists of cartilage (see Figures 3 and 4).

The vomer is a roughly triangular bone on the floor of the nasal cavity that articulates superiorly with the perpendicular plate of the ethmoid bone and sphenoid bone and inferiorly with both the maxillae and palatine bones along the midline (see Figure3). It forms the inferior portion of the bony nasal septum, the partition that divides the nasal cavity into right and left sides.

Figure 1. Nasal bones

Figure 2. Nasal bones

Figure 3. Nose cartilage (nasal septum)

Figure 4. Nose external anatomy

How to tell if your nose is broken

Symptoms of a broken nose may include:

• pain, swelling and redness
• a crunching or crackling sound when you touch your nose
• difficulty breathing out of your nose – it might feel blocked
• your nose changing shape – for example, it’s not as straight as before

You may also have:

• Bruising around the eyes (black eyes) (Figure 5)
• A cut on the bridge of the nose or a nosebleed (Figure 6).

Figure 5. Signs of a broken nose with bruising around the eyes (black eyes)

Figure 6. Broken nose – note a cut on the bridge of the nose or a nosebleed

What causes a broken nose?

Nasal fractures or broken noses, result from facial injuries in contact sports or falls. Injuries affecting the teeth and mouth may also affect the nose.

Common causes of a broken nose include:

• Injury from contact sports, such as football or hockey
• Physical altercations
• Motor vehicle accidents
• Falls

A broken nose can even be caused by walking into a fixed object, such as a door or wall, or by rough, wrestling-type play.

Risk factors for a broken nose

Any activity that increases your risk of a facial injury increases your risk of a broken nose. Such activities may include:

• Playing contact sports, such as football and hockey, especially without a helmet that has a face mask
• Engaging in a physical fight
• Riding a bicycle
• Lifting weights, especially if you don’t use a spotter
• Riding in a motor vehicle, especially without a seat belt

How can I prevent a broken nose?

• Wear protective gear to shield your face, such as a helmet with a face mask, when participating in contact sports
• Avoid fist fights
• Wear your seat belt when traveling in a motorized vehicle, and keep children restrained in age-appropriate child safety seats.
• Wear a helmet during bicycle or motorcycle rides.

Broken nose signs and symptoms

Signs and symptoms of a broken nose:

• Pain or tenderness, especially when touching your nose
• Swelling of your nose and on the bridge of your nose and surrounding areas
• Bleeding from your nose
• Bruising around your nose or eyes
• Crooked or misshapen nose
• Difficulty breathing through your nose
• Discharge of mucus from your nose
• Feeling that one or both of your nasal passages are blocked.

Broken nose diagnosis

Your doctor may press gently on the outside of your nose and its surrounding areas. He or she may look inside your nasal passage to check for obstruction and further signs of broken bones. Your doctor may use anesthetics — either a nasal spray or local injections — to make you more comfortable during the exam.

X-rays and other imaging studies are usually unnecessary. However, your doctor may recommend a computerized tomography (CT) scan if the severity of your injuries makes a thorough physical exam impossible or if your doctor suspects you may have other injuries.

Broken nose treatment

Broken nose First Aid

If you think you may have broken your nose, take these steps to reduce pain and swelling before seeing your doctor:

• Act quickly. When the break first occurs, breathe through your mouth and lean forward to reduce the amount of blood that drains into your throat.
• Use ice. Apply ice packs or cold compresses immediately after the injury, and then at least four times a day for the first 24 to 48 hours to reduce swelling.
• Keep the ice or cold compress on for 10 to 15 minutes at a time. Wrap the ice in a washcloth to prevent frostbite. Try not to apply too much pressure, which can cause additional pain or damage to your nose.
• Relieve pain. Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), as necessary.
• Keep your head up. Elevate your head — especially when sleeping — so as not to worsen swelling and throbbing.
• Limit your activities. For the first two weeks after treatment, don’t play any sports. Avoid contact sports for at least six weeks after your injury.

How to fix a broken nose

If your nose is broken but not out of position, you can usually treat a broken nose yourself.

You may need no treatment other than rest and being careful not to bump your nose.

It should start getting better within 3 days and be fully healed within 3 weeks.

DO

• hold an ice pack (or frozen peas) wrapped in a tea towel on your nose for up to 15 minutes, 2 to 3 times a day. DO NOT apply ice directly to the skin.
• take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) to relieve the pain. You can buy these pain medicines at the store.
• treat nosebleeds by sitting or standing upright and leaning forward – if possible, pinch your nose above the nostrils for up to 15 minutes
• keep your head upright when lying in bed by adding more pillows – this will help to reduce swelling
• treat minor cuts and grazes – if you have a small cut on your nose.

How to treat cuts and grazes

• Stop the bleeding

Stop any bleeding before applying a dressing to the wound. Apply pressure to the area using a clean and dry absorbent material – such as a bandage, towel or handkerchief – for several minutes.

• Clean the wound and apply a dressing

When the wound has stopped bleeding, clean it and cover it with a dressing to help stop it becoming infected.

To do this:

• wash and dry your hands thoroughly
• clean the wound under drinking-quality running tap water – avoid using antiseptic as it may damage the skin and slow healing
• pat the area dry with a clean towel
• apply a sterile adhesive dressing, such as a plaster – read more about how to apply plasters and other dressings

Keep the dressing clean by changing it as often as necessary. Keep the wound dry by using waterproof dressings, which will allow you to take showers.

You can remove the dressing after a few days, once the wound has closed itself.

• Take painkillers if needed

If the wound is painful for the first few days, you can take over-the-counter painkillers such as paracetamol or ibuprofen.

DON’T

• try to straighten your nose yourself if it’s changed shape – see a doctor instead
• wear glasses until the swelling has gone down, unless you need them
• pick or blow your nose until it’s healed
• do strenuous exercise for the first 2 weeks
• play sports where your face might be hit for at least 6 weeks

When to get medical help

A wound is at risk of infection if:

• it has been contaminated with dirt, pus or other bodily fluids
• there was something in the wound before it was cleaned, such as gravel or a shard of glass
• it has a jagged edge
• it’s longer than 5 cm (2 inches)

Signs a wound has become infected include:

• swelling, redness and increasing pain in the affected area
• pus forming in or around the wound
• feeling generally unwell
• a high temperature (fever) of 38 °C (100.4 °F) or above
• swollen glands under the chin or in the neck

An infected wound can usually be successfully treated with a short course of antibiotics.

Treating a severe broken nose in hospital

If your nose has changed shape

A doctor in hospital may be able to make your nose straighter using a procedure called manipulation. Manipulation is done using anesthetic so that you’re asleep or your nose is numbed. It doesn’t always make your nose look exactly the same as it was before, but it often helps. Your doctor will reposition the broken bones into place and then hold them in the right location with a “cast” made of plastic, plaster, or metal. This cast will then stay in place for a week. In the first two weeks after the injury, your doctor may offer you this kind of repair, or a similar approach using general anesthesia in the operating room.

You might have to go home and wait a few days for the swelling to go down, but the procedure should be done within 14 days for adults and 7 days for children from when the fracture occurred, preferably sooner.

If left untreated, a broken nose can leave you with an undesirable appearance as well as permanent difficulty in trying to breathe.

Manual realignment

If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them.

During this procedure, your doctor:

• Administers medication by injection or nasal spray to ease discomfort
• Opens your nostrils with a nasal speculum
• Uses special instruments to help realign your broken bones and cartilage

Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You’ll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose.

If you have a large wound

The wound will usually be cleaned and sealed with stitches or strips in hospital.

If your nose won’t stop bleeding

A doctor may place a soft gauze pad in your nose. The pad will be removed by the doctor a few days later.

If you have a septal hematoma

This is a collection of blood within the septum of the nose. The septum is the part of the nose between the 2 nostrils. An injury disrupts the blood vessels so that fluid and blood may collect under the lining. Your provider may have made a small cut to drain the blood.. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils. Septal hematoma requires prompt surgical drainage to prevent cartilage damage.

Broken nose surgery

Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may not be candidates for manual realignment. In these cases, surgery to realign the bones and reshape your nose may be necessary.

If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis.

If more than two weeks have passed since the time of your injury, you may need to wait a while before having your nose straightened surgically. It may be necessary to wait two to three months before a good repair can be done, by which time there will be less swelling and your nose will have begun to heal. Reduced swelling will allow the surgeon to get a more accurate picture of how your nose originally looked. This type of surgery is considered reconstructive plastic surgery, as its goal is to restore your appearance to the way it was prior to injury. If your repair is done within two weeks of the injury, restoring prior appearance is the only possible goal. If you have waited several months for the repair, it is often possible to change the appearance of your nose as you desire. Should you be interested in this kind of appearance change as well as repair, you can feel confident that your plastic surgeon or an ear, nose, and throat doctor is a specialist in all surgery of the nose. No other specialty has more training in surgery on the nose, and some plastic surgeon or an ear, nose, and throat doctor focus exclusively on plastic surgery of the face.