Nasal Fracture

Overview

A nasal fracture, commonly called a broken nose, is a break or crack in the bones or cartilage that make up the nose. Because the nose sticks out and its bones are relatively thin, it is the most frequently broken bone in the face. Nasal fractures range from a small crack with mild swelling to a severe break that visibly bends the nose or affects breathing.

Many broken noses heal well, sometimes without any special treatment beyond pain relief and time. Others need to be reset to restore appearance and breathing. Most nasal fractures are not dangerous on their own, but certain injuries to the nose and face can signal more serious damage that needs urgent care.

Symptoms

Symptoms of a broken nose appear right after the injury and may include:

• Pain and tenderness, especially when touching the nose
• Swelling of the nose and the area around it
• Nosebleed
• Bruising around the nose and sometimes under the eyes
• A crooked or misshapen nose
• Difficulty breathing through the nose
• A crunching or grating feeling when touching the nose

Swelling can hide a crooked nose at first, so the shape may only become clear once swelling goes down over a few days. Watch for warning signs such as heavy bleeding, clear watery fluid draining from the nose, or worsening difficulty breathing.

Causes

A nasal fracture is caused by a direct blow or impact to the nose or face. Common causes include:

• Sports injuries: Contact and ball sports such as basketball, soccer, hockey, and martial arts.
• Falls, especially in children and older adults.
• Physical altercations and assaults.
• Motor vehicle collisions.
• Accidents such as walking into a hard object or door.

Risk Factors

• Playing contact or high-impact sports without face protection
• Activities with a high risk of falls
• Riding in a vehicle without a seatbelt
• Physical fighting
• Conditions that increase the risk of falling

Diagnosis

A doctor can often diagnose a broken nose from an examination, looking at and gently feeling the nose. Assessment may include:

• Physical examination: Checking for tenderness, deformity, swelling, and breathing.
• Looking inside the nose: To check for bleeding and, importantly, a blood collection in the septum (septal hematoma) that needs prompt treatment.
• Imaging: X-rays are often not needed for a simple nasal fracture, but a CT scan may be used if more extensive facial injury is suspected.

The doctor may recheck the nose after a few days, once swelling subsides, to assess its shape and alignment.

Treatment

Treatment depends on how severe the fracture is and whether the nose is misaligned or breathing is affected.

• Home care for minor fractures: Ice packs, keeping the head elevated, and over-the-counter pain relief.
• Controlling bleeding: Gentle pressure on the soft part of the nose, leaning forward.
• Resetting the nose (reduction): If the nose is crooked or breathing is blocked, a doctor may realign the bones, usually within one to two weeks of the injury before they set.
• Surgery: For severe or complex breaks, or to correct shape and breathing later (rhinoplasty or septoplasty).
• Draining a septal hematoma: An urgent procedure if a blood collection forms in the septum, to prevent damage to the cartilage.

Prevention

• Wear a helmet with a face guard or mask in contact and high-impact sports
• Always use a seatbelt and proper child restraints
• Reduce fall hazards at home, especially for children and older adults
• Use appropriate protective equipment at work

When to See a Doctor

See a doctor for a suspected broken nose, especially if the nose looks crooked, breathing is difficult, or swelling and pain are significant. Seek emergency care right away if you have:

• A nosebleed that will not stop
• Clear, watery fluid draining from the nose, which can signal a more serious injury
• Difficulty breathing
• A head injury with confusion, vomiting, severe headache, or loss of consciousness
• A neck injury, severe facial deformity, or vision changes

A blood-filled swelling inside the nose (septal hematoma) also needs urgent treatment to prevent lasting damage.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Broken nose — Symptoms and causes.
2. MedlinePlus, U.S. National Library of Medicine. Broken nose.
3. American Academy of Otolaryngology-Head and Neck Surgery. Nasal fractures.
4. American College of Surgeons. Facial trauma resources.