Broken Nose

Definition

A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose — most commonly the bone over the bridge of your nose. A broken nose is a common injury, accounting for about 40 percent of all facial fractures.

The cause of a broken nose is trauma to your face. Common causes include contact sports, physical fights, falls and motor vehicle accidents.

Signs and symptoms of a broken nose include pain, swelling and bruising around the nose and under the eyes. Your nose may look crooked, and you may find it difficult to breathe.

Treatment for a broken nose may include procedures to realign your nose. Surgery rarely may be necessary.

Symptoms

Signs and symptoms of a broken nose may appear immediately or take up to three days to develop. Signs and symptoms may include:

Pain or tenderness, especially when touching your nose
Swelling 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 (rhinorrhea)
Feeling that one or both of your nasal passages is blocked

Causes

Because your nose is the most prominent feature on your face — protruding unprotected from your profile — it’s also the facial feature most at risk of injury. In fact, broken noses account for approximately 40 percent of all facial fractures.

Your nose is supported by cartilage (in the front) and bone (on the back and bridge). When this framework of bone and cartilage is struck with a force, the bones can crack or fracture — resulting in a broken nose.

Common causes of a broken nose include:

Injury from contact sports, such as football or hockey
Physical fights, such as those in which punches are thrown
Motor vehicle accidents
Falls
Accidental trauma, such as walking into a door or a fixed structure
Rough, wrestling-type play, in children

Risk factors

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 if you don’t wear a helmet with 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 if you don’t wear a seat belt

When to seek medical advice

Seek emergency medical attention if you experience a nose injury accompanied by:

A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness
Difficulty breathing
Bleeding that doesn’t stop after 15 to 30 minutes, depending on the severity of your injury
A noticeable change in the shape of your nose that isn’t related to swelling, such as a crooked or twisted appearance
Clear fluid draining from your nose

If the injury to your nose is minor — accompanied only by swelling and moderate pain — you may choose to wait 48 to 72 hours before deciding to see your doctor. This allows time for the swelling to subside, so you and your doctor can better evaluate your injury.

During this waiting period, get medical attention if:

The pain or swelling doesn’t progressively get better — and eventually disappear — within 72 hours.
Your nose looks misshapen or crooked after the swelling recedes.
You can’t breathe efficiently through your nose even after the swelling subsides.
You experience frequent, recurring nosebleeds.
You’re running a fever that’s one or more degrees above your normal body temperature.

Tests and diagnosis

During a physical exam, your doctor will ask about your injury, including the cause and any signs and symptoms. It’s a good idea to bring a “before” photograph for your doctor, since knowing the size, shape and appearance of your nose before injury can help him or her understand the extent of your trauma.

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. To look inside, your doctor may use an instrument (nasal speculum) designed to spread open your nostrils and a lighted tube (fiber-optic endoscope) to get the best look.

The exam to look inside your nasal passage will be uncomfortable. Anesthetics — in the form of nasal sprays or local injections — may be necessary to relieve your pain.

X-rays and other imaging studies are usually unnecessary. Rarely, your doctor may recommend a computerized tomography (CT) scan if he or she is unable to conduct a thorough physical exam due to the severity of your injury.

Complications

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 to one side, narrowing your nasal passage on one side. Medications, such as decongestants and antihistamines, can help you manage a deviated septum, though surgery is required to correct the condition.

Other complications, or injuries related to a broken nose, may include:

Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you may also experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgery would 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 (cervical spine). 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.
Collection of blood. Sometimes, a collection of blood called a septal hematoma may accompany a nose fracture. A septal hematoma can block one or both nostrils within hours of your injury. Septal hematoma requires surgical drainage to prevent cartilage damage.

Treatments and drugs

If you have a minor fracture that hasn’t caused your nose to become crooked or otherwise misshapen, professional medical treatment may be unnecessary. Your doctor may recommend simple self-care measures, such as using ice on the area and taking over-the-counter pain medications.

Closed reduction
If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them with a nonsurgical procedure called closed reduction. Closed reduction should be conducted within 10 days of the fracture.

During this procedure, your doctor uses a nasal speculum to open your nostrils. He or she then uses special instruments — including small forceps and a narrow tool called a Boies elevator — to help realign your broken bones and cartilage and return them to their original positions. You’ll likely receive pain medications, including local injections or nasal sprays, before the procedure.

If you experience persistent bleeding related to any nasal fracture, your doctor may pack your nostrils with moistened gauze strips. These strips, which may contain an antibiotic ointment, are usually removed within three days.

Surgery
Severe breaks, multiple breaks or breaks that have gone untreated for more than 10 days may not be candidates for closed reduction. In these cases, surgery to realign the bones and reshape your nose (rhinoplasty) may be necessary.

If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery called septorhinoplasty may be recommended.

Both surgeries are typically performed on an outpatient basis. Most people choose to stay home during the recovery process since considerable swelling and bruising are common side effects. Discomfort, swelling and bruising usually improve significantly after about one week.

Prevention

You can help prevent a nose fracture with these guidelines:

Wear your seatbelt when traveling in a motorized vehicle.
Wear the recommended safety equipment, such as a helmet with a face mask, when playing contact sports, such as hockey or football.
Wear a helmet during bicycle or motorcycle rides.
Mind your temper. Don’t engage in physical fights.