Broken Nose

A broken nose is also called a nasal fracture, which is either a break or crack in the bone or cartilaginous portion of your nose.

In most cases, the bone over the bridge of your nose is involved.

Nasal fracture is the most common fracture of the face and commonly occurs after an injury while playing contact sports, engaging in physical fights, falls and motor vehicle accidents that result in trauma to the face.

A fractured nose causes pain with swelling as well as bruising surrounding your nose and below your eyes.

Your nose may appear crooked and you may experience difficulty breathing.

A broken nose may be treated through corrective procedures that realign your nose.

Surgery is not always be required to treat a broken nose.

The signs and symptoms of a broken nose include:

• Pain or tenderness, especially when you touch your nose
• Swollen nose and face
• Blood leaking from your nose
• Bruising around your nose and eyes
• Deformed appearance of the nose (crooked or bent)
• Trouble breathing through your nose
• Mucus discharge from your nose
• A stuffy nose or feeling that one or both of your nasal passages are blocked

Seek emergency medical care if you experience an injury to your nose accompanied by the following:

• A head or neck injury with a severe headache, neck pain, vomiting or loss of consciousness
• Difficulty breathing
• Incessant bleeding
• A noticeable deformation of your nose that is not because of swelling, such as a crooked or twisted appearance
• Clear, watery fluid leaking from your nose

The most common causes of a broken nose are injury to the face during to the following conditions:

• Contact sports injuries such as while playing football or hockey
• Falls or walking into a hard object such as a wall or door
• Getting hit on the nose during boxing/wrestling
• Motor vehicle accidents
• Physical violence or altercations

Making a diagnosis of broken nose is done by several tests.

In case of severe injury, you will need to seek immediate medical care, and you will not have time to prepare for your appointment.

But, if you feel the injury is less severe — accompanied by moderate pain and swelling, you may wait a few before seeing your doctor.

This provides time for the swelling to subside so that your doctor will be able to evaluate your condition better.

However, you should not wait more than three to five days before seeing your doctor if your signs and symptoms are persistent.

During this period of waiting, seek medical advice if:

• The pain or swelling does not progressively improve over time
• Your nose appears deformed or crooked even after the swelling subsides
• You cannot breathe properly through your nose even after the swelling recedes
• You get frequent nosebleeds
• You develop a fever

While making an appointment, you will probably consult your primary care doctor initially.

However, you will be referred to a doctor who specializes in treatment of disorders of the ear, nose and throat if necessary.

Here is some information that helps you get ready for your appointment.
Make a list of the following:

• All the symptoms that you have and information about how the injury took place.
• Your regular medications, vitamins and supplements

Prepare a list of questions that you want to ask your doctor.

For a broken nose, some basic questions to ask your doctor include:

• What diagnostic test will be required?
• For how long will the swelling and bruising last?
• Will my nose look the same as before? Do I need to undergo corrective surgery?
• What activities should be restricted?
• What kind of pain relievers can I take?

Your doctor may ask:

• How and when did you injure your nose?
• Have your symptoms improved?
• Do you feel your nose is normally shaped or does it appear deformed?
• Do you have difficulty breathing through your nose?
• Are you involved in contact sports?

During the physical examination, your doctor may gently apply pressure on the outside of your nose and its surrounding areas.

Your doctor will inspect your nasal passages to rule out obstruction and other signs of broken bones.

Your doctor will give you anesthetics in the form of a nasal spray or local anesthesia injections to keep you more comfortable during the examination.

X-rays and other imaging studies will usually not be necessary.

However, your doctor may order a computerized tomography (CT) scan if the severity of your injury makes a thorough physical examination uncomfortable or if your doctor suspects other associated injuries.

You may not need any medical treatment of broken nose if your nasal fracture is minor with no changes in its appearance.

Simple self-care measures such as ice application and pain relievers would be recommended in such cases.

Fixation of displaced fractures and breaks

Your doctor may realign your nose either manually or through surgery.

Manual realignment: If the bones and cartilage have been displaced during the injury, your doctor will be able realign them into correct position manually.

This should be done within 14 days of the injury or sooner.

During this procedure, your doctor will follow these steps:

• Administration of an anesthetic medication either by injection or nasal spray to reduce your discomfort
• Opening your nostrils using a nasal speculum
• Use of special instruments to realign your broken bones and cartilage
• Finally, your doctor will splint your nose with the use of packing inside your nose. Sometimes an internal splint will be put in for a short period of time. The packing should be in place for at least a week. An antibiotic will be prescribed to prevent infection from the bacteria that resides in your nose.

Surgery: Severe fractures, multiple fractures or a broken nose that has remained untreated for more than 14 days may not be ideal candidates for manual realignment.

In such cases, surgery for realignment of the bones and reshaping of your nose will be considered.

Reconstructive surgery will be necessary if there is damage to your nasal septum that causes obstruction or difficulty breathing.

Surgery is performed on an outpatient basis.

It is possible to prevent or at least reduce the risk of a broken nose by taking these safety precautions:

• Wear your seat belt while driving or being a passenger in a motor vehicle
• While traveling, make sure your children are properly restrained with age-appropriate child safety seats
• Wear a helmet during motorcycle or bicycle rides
• Wear the recommended safety equipment, such as headgear with a face mask, while playing hockey, football or other contact sports.
• Use shoes with a good grip to prevent falls

Lifestyle modifications are necessary in order to cope with broken nose.

If you get severely injured on your face and you feel you have fractured your nasal bone, immediately follow these steps to manage the pain and swelling:

• Act quickly: When you have sustained a nasal fracture, try to breathe through your mouth and bend forwards to prevent blood from draining into your throat.
• Apply ice: Immediately after the injury, you can place ice packs or cold compresses over the injured area, and then onward at least 4 times a day for the first 1-2 days to decrease the swelling. The ice-pack should be applied for about 10 -15 minutes each time. Wrap the ice cubes around a washcloth to prevent frostbite. Apply the cold compress gently without using too much pressure.
• Pain management: Take over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve) when necessary.
• Keep your head at a higher position: Elevate your head, particularly while sleeping to decrease swelling and throbbing sensations.
• Restrict your activities: For the first two weeks after treatment, avoid getting involved in any kind of sports activities. Further, it is recommended to avoid contact sports for a period of at least 6 weeks after your injury.

Certain physical activities are considered to be associated with a higher risk of getting a broken nose.

These activities include:

• Playing contact sports, such as football or hockey, particularly if you do not wear the necessary safety headgear with a face mask
• Engaging yourself in physical fights or violence
• Riding a bicycle without a helmet
• Riding in a motor vehicle without fastening your seat belt

The possible complications or injuries related to a broken nose may include:

• A deviated nasal septum: A fractured nose may cause a deviated nasal septum, a condition in which the thin cartilage that divides your nose (nasal septum) gets displaced, thus narrowing your nasal passage. Medications such as decongestants and antihistamines may be helpful in managing a deviated septum, but surgical correction will be required for complete resolution of the problem.
• Collection of blood: Septal hematoma may occur sometimes, when blood clots get collected in a broken nose. This may block one or both of your nostrils. It requires immediate surgical drainage to prevent damage to the cartilage.
• Fracture of the cartilage: If your fracture has occurred due to a forceful direct blow such as from a motor vehicle accident, you may sustain a cartilage fracture.
• Neck injury: Nasal fractures occurring as a result of high-velocity injuries such as motor vehicle accidents may also be accompanied by a neck injury.