A broken nose involves a crack or break in the bones or cartilage that form the structure of the nose. This common facial injury occurs most frequently at the bridge of the nose, causing immediate pain and visible changes. The severity of the fracture can range from a minor crack that heals on its own to a complex displacement requiring medical intervention.
Immediate First Aid and Symptom Assessment
The first priority following any nasal trauma is to control bleeding and manage swelling. If a nosebleed is present, sit upright and lean your head slightly forward to prevent blood from draining down your throat. Gently pinch the soft part of the nose just above the nostrils for a sustained period of 10 to 15 minutes, breathing through your mouth during this time.
To minimize swelling, immediately apply a cold compress or an ice pack wrapped in a thin cloth to the nose for 10 to 15 minutes at a time. This should be repeated several times an hour for the first one to two days after the injury. Keeping your head elevated, even while sleeping, can help reduce the accumulation of fluid in the facial tissues.
For pain management, over-the-counter pain relievers like acetaminophen are recommended. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be avoided initially, especially if bleeding is heavy, as they can increase the risk of hemorrhage. Signs of a fracture include severe pain, bruising that spreads under the eyes, and a crunching or crackling sound when the nose is lightly touched.
Determining When to Seek Medical Care
While minor nasal injuries can often be managed at home, certain symptoms require immediate medical attention. One urgent concern is a septal hematoma, a collection of blood on the septum inside the nose. This condition can deprive the nasal cartilage of its blood supply, necessitating immediate drainage to prevent severe complications, such as a saddle nose deformity.
Medical care is necessary if you experience bleeding that cannot be stopped after 20 minutes of continuous pressure. Seek emergency evaluation if you have clear, watery fluid persistently draining from one or both nostrils, as this may indicate a leak of cerebrospinal fluid (CSF) from the brain. Any injury that causes severe difficulty breathing or a significant, visible deformity not solely due to swelling should prompt a visit to a healthcare provider.
If the injury does not present immediate emergency signs, wait three to five days for the initial swelling to subside before seeking a consultation. This reduction in swelling allows the doctor to accurately assess the underlying damage and determine if the bones are misaligned. If a deformity remains visible after the swelling has gone down, or if breathing remains obstructed, a procedure will likely be required.
Professional Treatment Options
The treatment approach for a broken nose depends on the severity of the fracture and whether the nasal bones are displaced. For fractures where the bones have shifted out of alignment, a procedure called closed reduction is often performed. This non-surgical technique involves the doctor manually realigning the broken bones and cartilage using specialized instruments.
Closed reduction is typically performed under local anesthesia and must be completed within 7 to 14 days of the injury, before the bones begin to fixate in the wrong position. After this window, the bones become too stable to manipulate without more invasive measures. Following the manual realignment, the nose is often stabilized with internal packing or an external splint to maintain the new position.
In cases of severe, complex fractures, or when a septal hematoma or a significant septal deviation is involved, surgical intervention may be required. This more extensive procedure, known as an open reduction or septorhinoplasty, involves making small incisions to directly visualize and repair the bone and cartilage. Open reduction is reserved for complicated or older fractures and may be delayed for up to three months to ensure swelling has resolved, leading to a more accurate repair.
Managing the Healing Process
Following any treatment, the recovery process requires patience and careful monitoring. The most noticeable symptoms, like swelling and bruising, will gradually resolve over the first one to two weeks, though minor swelling can linger for several months. Full bony healing, where the fracture site becomes stable, takes approximately three to six weeks.
If a reduction procedure was performed, you may have nasal packing inside the nostrils for several days, which helps support the septum and control any residual bleeding. An external splint or cast will also be worn for about one to two weeks to protect the nose from accidental bumps and maintain the corrected alignment. It is important to avoid blowing your nose forcefully during the initial healing phase to prevent disrupting the repair.
For several weeks, specific activity restrictions must be followed to prevent re-injury or displacement. Avoid contact sports for at least six weeks, and refrain from strenuous activities or heavy lifting for the first two weeks. If you wear glasses, temporarily replace them with contacts or tape them to your forehead to avoid pressure on the healing nasal bridge. Monitor the nose for signs of infection, such as fever or increasing pain, and report persistent pain or difficulty breathing to your healthcare provider.