Nasal Fractures

A nasal fracture (or broken nose) is a break or crack in a bone in your nose — often the bone over the bridge of your nose. It is the most common type of facial fracture.

Common causes of a nasal fracture include

• Contact sports
• Physical fights
• Falls
• Motor vehicle accidents that result in facial trauma
• Walking into a fixed object, such as a door or wall
• Rough, wrestling-type play

If you participate in activities that increase your risk of a facial injury then they will likewise increase your risk of a broken nose. Such activities may include:

• Playing contact sports, especially without a helmet that has a face mask
• Engaging in a physical fight
• Riding a bicycle
• Riding in a motor vehicle, especially without a seat belt
• Playing with young children, dogs

The signs and symptoms of a broken nose 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
• Feeling that one or both of your nasal passages are blocked

Several complications can develop as a result of a nasal fracture, including

• 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 may help you temporarily minimize the obstruction caused by a deviated septum, but surgery is required to correct the condition.
• Collection of blood or septal hematoma – Sometimes a pool of clotted blood forms in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils, so prompt surgical drainage is required 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 require surgical treatment, your surgeon will address both your bone and cartilage injuries.

You should seek emergency medical attention if you experience a nose injury and:

• A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness
• Bleeding you can’t stop
• Clear, watery fluid draining from your nose

Other signs of a fracture may not necessarily require emergency medical attention; however, you should follow up with your doctor within a few days of the injury:

• Difficulty breathing through the nose
• Noticeable change in the shape of your nose unrelated to swelling, such as a crooked or twisted appearance

Treatment for a broken nose may include procedures that realign your nose.

Correction of a nasal fracture may be indicated if permanent deformity or breathing obstruction is likely to be the long-term result. “Closed reduction” involves “setting” the displaced nasal bones back in place. This is most commonly done under sedation or general anesthesia for the patient’s comfort. This procedure must typically be done within the first 7-10 days following injury before the bones begin to heal in an improper position.

If a significant deviation of the nasal septum is present along with significant deformity to the nose, an ‘open reduction” may be the better choice for correction of the fracture. This is typically performed a minimum of 6 weeks after injury in order to allow for the swelling to resolve. This involves making incisions inside the nose or in the columella (between the nostrils) as is performed in a rhinoplasty. This allows for a more thorough and precise correction of any external deviation or septal deviation in order to improve breathing.

If desired, cosmetic nasal reshaping, or rhinoplasty, may be performed at the same time as open reduction. In addition to correcting the deformity caused by the nasal injury, changes such as narrowing of the nasal tip or reducing a hump on the bridge of the nose may be performed at the same operative session.

Follow these guidelines to decrease your risks of a nasal fracture:

• Wear your seat belt when traveling in a motorized vehicle, and keep children restrained in age-appropriate child safety seats.
• Wear the recommended safety equipment, such as a helmet with a face mask, when playing hockey, football or other contact sports.
• Wear a helmet during bicycle or motorcycle rides even if the state where you live doesn’t require it.