The nose’s prominent position makes it vulnerable to accidental bumps and injuries, often causing concern for parents. A nasal fracture, commonly called a broken nose, refers to a break in the bone or cartilage forming the nasal structure. While many injuries result only in soft tissue damage like bruising and swelling, determining if a fracture has occurred requires careful observation. Understanding the difference between a minor injury and a serious one helps parents make informed decisions about seeking medical care.
Emergency Signs Requiring Immediate Medical Attention
Certain signs following a nasal injury indicate a need for immediate attention at an emergency room, as they suggest complications beyond a simple fracture. Persistent difficulty breathing, or noisy breathing that continues after the child clears their nose, is a serious sign. Severe bleeding that cannot be stopped after 15 to 20 minutes of direct pressure also warrants immediate medical intervention.
Septal Hematoma
The presence of a septal hematoma is an urgent concern that requires swift drainage to prevent permanent damage. This condition involves a collection of blood between the cartilage and its lining, appearing as a dark blue or purple bulge on the septum inside the nose. The hematoma blocks the nasal passages and can lead to necrosis of the cartilage if not treated quickly.
Clear, watery fluid leaking from the nose after a high-impact injury may indicate a cerebrospinal fluid (CSF) leak, which involves a tear in the membrane surrounding the brain. This sign suggests a potential skull base fracture and carries an increased risk of infection. Signs of a concurrent head injury, such as loss of consciousness, repeated vomiting, or a severe, worsening headache, also necessitate an immediate emergency evaluation. Bruising around both eyes that develops after the injury, often called “raccoon eyes,” may signal a fracture at the base of the skull.
Common Symptoms of a Possible Nasal Fracture
If the injury does not present with emergency signs, parents can look for common symptoms that point toward a possible nasal fracture requiring non-emergency medical follow-up. Localized and persistent pain, especially when the bridge of the nose is gently touched, is a common indicator of a break. Significant swelling usually appears quickly, often obscuring the nose’s normal shape.
Bruising is expected with blunt trauma and may spread around the eyes, though this is distinct from the “raccoon eyes” sign of a skull fracture. Parents might observe a visible deformity or crookedness, but swelling can initially mask the nose’s true alignment. A grating or crunching sensation, known as crepitus, may be felt when lightly touching the injured area, resulting from broken bone fragments moving against one another. A fracture is more likely if nosebleeds are heavy or last longer than typical minor nosebleeds.
Immediate First Aid and Next Steps
The first step after any nasal injury is to keep the child calm and still, sitting them upright to help minimize swelling. Apply a cold compress or ice pack, wrapped in a thin cloth, to the bridge of the nose for 10 to 15 minutes to reduce pain and swelling. This should be repeated every one to two hours for the first 24 hours.
If a nosebleed occurs, instruct the child to lean slightly forward and pinch the soft part of the nose just above the nostrils. Leaning forward prevents blood from draining down the throat, which can cause nausea or vomiting. Maintain continuous pressure for a full 10 minutes without checking to see if the bleeding has stopped.
For pain management, over-the-counter medications like acetaminophen or ibuprofen can be given according to guidelines. If the nose is visibly crooked, or if the pain and swelling are significant, a medical evaluation is recommended. If the injury is minor and there are no emergency signs, many fractures are best assessed three to seven days after the injury, once the initial swelling has started to subside.
What to Expect During Professional Diagnosis and Treatment
A physician relies primarily on a thorough physical examination to diagnose a suspected nasal fracture. This includes checking for a septal hematoma and carefully feeling the nasal structure to assess for misalignment or bone movement. Imaging, such as X-rays or CT scans, is often unnecessary for an isolated nasal fracture because the diagnosis is based on the exam and functional status.
If the nose is fractured and significantly displaced, a procedure known as closed reduction may be necessary to restore alignment. In children, this procedure is commonly performed under general anesthesia to ensure proper alignment. The timing for a closed reduction is narrow, ideally performed within three to seven days of the injury, or up to 14 days, before the fracture fragments begin to set in the wrong position.
Following the reduction, the nose may be stabilized with internal packing or external splints. Recovery typically involves avoiding contact sports for several weeks to allow the bones to heal securely. Treatment focuses on restoring both the appearance and the ability to breathe through the nose.