OhioHealth Online

A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose — often the bone over the bridge of your nose.

Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in facial trauma.

Signs and symptoms of a broken nose include pain, swelling and bruising around your nose and under your 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 usually isn't necessary for a broken nose.

Signs and symptoms of a broken nose may appear immediately or may 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 are blocked

When to see a doctor
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 you can't stop
• 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

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

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

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

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

If you're injury is severe, you'll need to seek immediate medical attention and won't have time to prepare for your appointment. But, if the injury to your nose is minor — accompanied only by swelling and moderate pain — you may choose to wait before seeing your doctor. This allows time for the swelling to subside, so you and your doctor can better evaluate your injury.

However, it's best not to wait longer than a week before seeing your doctor if your signs and symptoms persist. And, during this waiting period, get medical attention if:

• The pain or swelling doesn't progressively get better — and eventually disappears.
• 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.

You'll probably start by seeing your family doctor or general practitioner. However, he or she will likely refer you to a doctor who specializes in disorders of the ear, nose and throat (otolaryngologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, and let your doctor know what you were doing at the time of the injury.
• Make a list of all medications, vitamins and supplements that you're taking.
• Bring a photo of yourself before the injury for comparison, if possible.
• Write down questions you want to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time can help you make the most of your time together. For a broken nose, some basic questions to ask your doctor include:

• Do I need any tests, such as X-rays?
• How long will the swelling and bruising last?
• Will my nose look the same?
• Do I need surgery?
• Are there any activity restrictions that I need to follow?
• What type of pain medication can I take?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

What to expect from your doctor
Your doctor may ask:

• How and when did your injury occur?
• Have your symptoms improved at all since the time of the injury?
• Does your nose look normal to you?
• Can you easily breathe through your nose?
• Do you participate in contact sports? If so, how long do you plan on participating in this sport?

What you can do in the meantime
Immediately after your injury, apply ice to the area to help keep swelling down. Use light pressure to keep the ice on your nose. Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), can help reduce pain. Ibuprofen can also help relieve inflammation.

During a physical exam, your doctor will ask about your injury, including the cause and any signs and symptoms. If you can, it's helpful 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. However, 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, or if he or she suspects you may have other injuries.

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.

Fixing displacements and breaks
Your doctor may use one of two approaches:

• 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 no more than 14 days after the fracture.

  During this procedure, your doctor uses a nasal speculum to open your nostrils. He or she then uses special instruments 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 will likely contain an antibiotic ointment to help prevent infection.

• Surgery. Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 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. Many 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.

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. Place a washcloth between your skin and the ice 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) or ibuprofen (Advil, Motrin, others), as necessary.
• Keep your head up. Elevate your head — especially when sleeping — to help reduce additional swelling and throbbing.

You can help prevent a nose fracture with these guidelines:

• 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 contact sports, such as hockey or football.
• Wear a helmet during bicycle or motorcycle rides.
• Control your temper. Don't engage in physical fights.