Nasal Fractures

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A broken nose, or nasal fracture, can significantly alter your appearance. It can also make it much harder to breathe through your nose. Getting struck on the nose, whether by another person, a door, or the floor is not pleasant. Your nose will hurt, usually a lot. You’ll likely have a nose bleed and soon find it difficult to breathe through your nose. Swelling develops both inside and outside the nose, and you may get dark bruises around your eyes (black eyes).

Nasal fractures can affect both bone and cartilage. 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.

What Are the Symptoms of a Nasal Fracture?

Symptoms of a nasal fracture can include:

Pain
Displaced bone and/or cartilage (nasal septum)
Changes in the appearance (shape) of the nose
Nose bleed
Difficulty breathing through the nose
Collection of blood (septal hematoma)
Swelling and bruising of nose and eyelids

What Causes a Nasal Fracture?

Nasal fractures, or broken noses, may result from facial injuries in contact sports or falls. Injuries affecting the teeth and mouth may also affect the nose. To help prevent a broken nose, wear protective gear to shield your face when participating in contact sports.

If you’ve been struck in the nose, it’s important to see a physician to check for septal hematoma. Seeing your primary care or an emergency room physician is usually the best way to determine if you have a septal hematoma or other associated problems from your accident. If a septal hematoma is present, it must be treated promptly to prevent worse problems from developing in the nose.

If you suspect your nose may be broken, you should see an ENT (ears, nose, and throat) specialist, or otolaryngologist, within one week of the injury. If you are seen within one to two weeks (one week for children), it may be possible to repair your nose immediately. If you wait longer than two weeks, you will likely need to wait several months before your nose can be surgically straightened and fixed. An untreated broken nose can leave you with an undesirable appearance, as well as permanent breathing difficulty.

What Are the Treatment Options?

Your doctor will ask you several questions and examine your nose and face. You will be asked to explain how the fracture occurred, the state of your general health, and how your nose looked before the injury (bring a picture to your appointment, if possible). Your doctor will examine not only your nose, but also the surrounding areas including your eyes, jaw, and teeth, and will look for bruising, cuts, and swelling.

Sometimes your physician will recommend an X-ray or computed tomography (CT) scan. These can help identify other facial fractures, but are not always helpful in determining if you have a broken nose. The best way to determine that your nose is broken is if it looks very different or is harder to breathe through.

If your nose is broken but not out of position, you may need no treatment other than rest and being careful not to bump your nose.

If your nose is broken so badly that it needs to be repositioned, you have several options. Your nose can be repaired in the office in some situations. However, many situations require general anesthesia, particularly if the septum has also been damaged. Your doctor can give you local anesthesia, reposition the broken bones into place, and then hold them in the right location with a plastic, plaster, or metal cast. This cast will then stay in place for one 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.

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 begin to heal as best it can. 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 and breathing 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 through combined nasal fracture repair and rhinoplasty procedures.

What Questions Should I Ask My Doctor?

Should I be on antibiotics or other medications after a nasal fracture?
What physical activities can I do while healing?
Can there be secondary treatments after my initial corrective surgery if needed?
If there were cuts or lacerations associated with my nasal fracture, when can scar revision procedures be addressed?