A nasal fracture, commonly known as a broken nose, is a break or crack in the bone or cartilage that forms the structure of the nose. It is one of the most frequent facial injuries, often resulting from trauma such as contact sports, accidental falls, or motor vehicle accidents. Since the nose sits prominently on the face, it is particularly vulnerable to impact. A rapid assessment of the injury is important for ensuring proper care and preventing long-term complications.
Identifying the Signs of a Nasal Fracture
The immediate aftermath of a blow to the nose involves physical indicators that help distinguish a fracture from a minor bruise. Severe, persistent pain and tenderness, especially when touching the area, are primary signs of a potential break. This pain is often accompanied by swelling in and around the nose, which can extend to cause bruising around the eyes, sometimes referred to as “black eyes.”
A visible change in the shape of the nose is a strong indicator of a displaced fracture. The nose may appear crooked, bent, or noticeably off-center compared to its pre-injury appearance. However, significant swelling can sometimes make a non-fractured nose appear crooked, so a definitive assessment may need to wait until the swelling subsides.
Another specific sign of bone damage is a crunching or grating sensation when the nose is gently touched or moved. This mechanical sound, known as crepitus, indicates that fractured bone fragments are rubbing against each other. Difficulty breathing through the nostrils may also occur due to swelling or a blockage caused by shifted bone or cartilage.
Nosebleeds are common following a nasal injury, but persistent bleeding is more concerning. The feeling of one or both nasal passages being blocked, even after the initial bleeding has stopped, suggests internal obstruction. Bruising and swelling of the nasal septum—the wall separating the nostrils—can lead to a septal hematoma. This collection of blood can block the airway and requires prompt attention.
Immediate First Aid Steps
Taking immediate action after a nasal injury helps manage symptoms while waiting for professional evaluation. If a nosebleed occurs, the person should sit or stand upright and lean slightly forward. This prevents blood from draining down the throat and potentially causing nausea or vomiting. Gently pinching the soft, fleshy part of the nose just below the bony bridge for 10 to 15 continuous minutes can help stop the bleeding.
Applying a cold compress or an ice pack wrapped in a thin cloth to the nose reduces immediate swelling and provides pain relief. The ice should be applied for 10 to 15 minutes at a time, repeated every few hours for the first 24 to 48 hours. Keeping the head elevated, even while sleeping, by using extra pillows also helps minimize swelling and throbbing sensations.
Over-the-counter pain relievers, such as acetaminophen, can be used to manage pain. Acetaminophen is recommended because non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin can increase the risk of bleeding. Avoid attempting to straighten or manipulate the nose, as this can cause further injury or displacement of fractured segments.
When to Seek Urgent Medical Attention
Certain symptoms following a nasal injury are considered “red flags” and indicate a severe complication that requires immediate medical care. Persistent, heavy bleeding that cannot be stopped after 15 to 20 minutes of continuous pressure is a serious concern. Uncontrolled bleeding can signal a deeper injury or vascular issue.
Another urgent sign is clear, watery fluid draining from the nose, particularly if it has a salty or metallic taste. This clear discharge could be cerebrospinal fluid (CSF), suggesting a serious head injury or a fracture that has breached the barrier between the brain and the nasal cavity. Symptoms suggesting a possible concussion also require emergency evaluation. These include a severe headache, dizziness, loss of consciousness, or repeated vomiting.
Significant bruising and swelling inside the nose that creates a noticeable blockage of both nostrils may indicate a septal hematoma. If left undrained, this collection of blood can damage the underlying cartilage and lead to a permanent deformity or infection. Sudden changes in vision or eye pain, or signs of a neck injury such as neck pain or numbness in the arms, also necessitate immediate medical attention.
Professional Diagnosis and Treatment Options
A healthcare professional diagnoses a nasal fracture through a thorough physical examination, feeling the nose for pain, tenderness, and displacement. The physician will also look inside the nose to check for internal injuries or a septal hematoma. In many straightforward cases, imaging tests like X-rays or CT scans are not needed, as a clinical examination provides enough information for diagnosis and treatment planning.
If the fracture is minor and the nose is not noticeably crooked, treatment involves conservative management with ice and pain medication. If the bones or cartilage are displaced, a procedure called closed reduction is the most common treatment. This involves manually realigning the bone fragments back into place, usually performed under local anesthesia. The procedure is most effective when performed within 7 to 14 days of the injury, before the bones set in the wrong position.
Following the reduction, the nose may be stabilized using internal packing or an external splint to hold the structure in place while it heals. For severe or complex fractures, those involving multiple breaks, or those assessed more than 14 days after the injury, a more invasive surgery may be required. This surgical approach, sometimes called open reduction or rhinoplasty, allows the surgeon to directly access and repair the bones and cartilage.