Nasal Fracture (Broken Nose)

First aid for a broken nose

1. Stop the bleeding: sit up, lean forward and pinch the soft part of the nose firmly for 10 to 15 minutes without letting go. Breathe through your mouth. Do not tilt your head back.
2. Cool it: hold an ice pack wrapped in a cloth over the nose for 10 to 15 minutes at a time, several times a day for the first 2 days. Avoid pressing hard.
3. Pain relief: acetaminophen (paracetamol) is a good first choice. Ibuprofen also helps; some doctors advise waiting a day or two if bleeding was heavy. Follow the label dose.
4. Keep your head up, including sleeping with extra pillows, to reduce swelling.
5. Do not blow your nose for several days, and do not try to straighten it yourself.

Symptoms

• Pain and tenderness, worse when the nose is touched
• Swelling of the nose and the area around it, peaking at 1 to 3 days
• A nosebleed at the time of injury
• Bruising under the eyes ("black eyes")
• A crooked, flattened or dented nose
• A crunching or crackling feeling when the nose is touched
• Difficulty breathing through one or both sides

Swelling can hide a deformity for several days, so the final shape is easier to judge after 3 to 7 days.

How to tell if your nose is broken

There is no reliable home test. A broken nose is likely if:

• the nose looks bent, flattened or shifted to one side
• you heard or felt a crack at the moment of injury
• the bridge feels uneven or moves when gently pressed
• breathing through one side is blocked by more than swelling alone

Not every injured nose is broken. A bruised nose has similar swelling and pain but heals in a week or two without any change in shape.

Septal hematoma: the complication not to miss

The septum is the wall of cartilage and bone dividing the nostrils. A blow can cause bleeding under its lining, forming a septal hematoma. It looks like a soft, purple or red swelling on one or both sides of the septum and blocks the nostril.

The cartilage gets its blood supply from that lining. If the clot is not drained within about 24 to 72 hours, the cartilage can die or become infected, leading to an abscess or collapse of the bridge (saddle nose deformity). Children are particularly at risk. A doctor drains it through a small cut and packs the nose.

Causes

• Assaults, especially punches
• Contact and ball sports: boxing, martial arts, football, basketball, hockey
• Falls, particularly in older adults and young children
• Car and bike crashes
• Walking into objects

In young children, a broken nose without a clear accidental cause should prompt questions about how it happened.

How a broken nose is diagnosed

A doctor examines the nose from the front and above, feels the bones, and looks inside with a light to check the septum. They also check the eyes, cheekbones, jaw and teeth and look for signs of a head injury.

X-rays are usually not needed for an isolated broken nose because they do not change treatment. A CT scan is done if other facial fractures or serious injury are suspected.

You may be asked to return after 3 to 7 days, once the swelling has settled, so the shape can be assessed accurately.

Treatment

Non-displaced fractures

If the nose is straight and you can breathe well, no specific treatment is needed. Ice, pain relief, head elevation and time are enough.

Resetting a crooked nose (closed reduction)

If the nose is visibly bent, an ear, nose and throat (ENT) or facial plastic surgeon can push the bones back into position. This is usually done:

• within about 10 to 14 days of the injury in adults, sooner in children, before the bones set
• under local anesthetic or a short general anesthetic
• without cuts in the skin

A splint is worn on the outside of the nose for about a week, and sometimes soft packing inside for a day or two.

Later surgery

If the nose has healed crooked, or breathing remains blocked by a deviated septum, surgery can be done after about 3 to 6 months, once healing is complete. Rhinoplasty reshapes the outside of the nose, and septoplasty straightens the septum. They are often combined.

Recovery and healing time

• Swelling eases noticeably within 1 week; bruising fades over 2 weeks.
• The bones are stable at about 3 weeks, and fully healed at about 6 weeks.
• Avoid contact sports for at least 4 to 6 weeks, and wear a face guard when you return.
• Avoid glasses resting on the bridge for a few weeks if the nose was reset, or tape them to the forehead.

Frequently asked questions

Can a broken nose heal on its own?

Yes. A broken nose that is still straight, with clear breathing, usually heals by itself in about 3 weeks. If it is crooked or you cannot breathe well, it may heal in the wrong position, and resetting within the first 1 to 2 weeks gives the best result.

How long does a broken nose take to heal?

Swelling and bruising settle over 1 to 2 weeks. The bones are reasonably stable at 3 weeks and fully healed at around 6 weeks. Contact sports should wait at least 4 to 6 weeks.

Do I need to go to the ER for a broken nose?

Go to the ER for a nosebleed that will not stop, clear fluid from the nose, a head injury, vision problems or difficulty breathing. Otherwise, see a doctor within a few days, and the same day if a nostril is completely blocked by a swelling inside.

Why do I have black eyes after breaking my nose?

Blood from the injury tracks under the thin skin around the eyes, causing bruising that often appears a day or two later. It fades over about 2 weeks. Black eyes with double vision, vision changes or difficulty moving the eye need urgent checking.

Can a broken nose be fixed years later?

Yes. A nose that healed crooked or causes breathing problems can be corrected with rhinoplasty and septoplasty at any point once healing is complete, usually at least 3 to 6 months after the injury.