A broken nose, technically known as a nasal fracture, involves a break or crack in the bony or cartilaginous structures of the nose. It is the most common type of facial fracture due to the nose’s exposed position. Treatment depends directly on the location and severity of the damage. A simple crack may require minimal intervention, while a severe injury with bone displacement often requires a procedure to restore function and appearance.
Recognizing the Injury
A forceful impact to the nose results in immediate pain, followed rapidly by significant swelling (edema). Bruising is a common sign, often appearing as a dark discoloration beneath the eyes, medically termed periorbital ecchymosis. This “black eye” appearance is caused by blood spreading from the fracture site.
The nasal structure may look visibly crooked, or you might hear a crunching sound (crepitus) when touching the nose gently. Breathing can become difficult if the internal lining is swollen or if the septum, the wall dividing the nostrils, is displaced. Nosebleeds (epistaxis) are frequent, resulting from the tearing of the mucosal lining inside the nose at the time of injury.
Immediate Care and Triage
The first steps after a suspected nasal fracture focus on controlling bleeding and reducing swelling until medical help is reached. If the nose is actively bleeding, sit upright, lean slightly forward, and firmly pinch the soft, lower part of the nose for at least 15 minutes. Leaning forward prevents blood from draining down the throat, which can cause nausea.
Applying a cold compress or ice wrapped in a thin towel to the nose for 15-to-20-minute intervals helps constrict blood vessels and limit swelling. For pain management, acetaminophen is preferable to non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as they can increase the risk of further bleeding. Emergency room attention is necessary if bleeding cannot be stopped, or if a clear, watery fluid drains from the nose, which may indicate a cerebrospinal fluid leak. A purplish swelling on the nasal septum, called a septal hematoma, requires urgent drainage to prevent cartilage damage and permanent deformity.
Medical Assessment and Closed Reduction
A medical professional diagnoses a nasal fracture primarily through a physical examination, often using a nasal speculum to inspect the inside of the nose. This assessment checks for septal integrity and confirms the patency of the nasal airways. Imaging, such as X-rays, is unnecessary for isolated nasal fractures because the diagnosis is clinical, and X-rays do not clearly show cartilage damage.
For simple fractures where the bone is minimally displaced, closed reduction is the standard treatment. This non-surgical technique involves realigning the bone fragments without external incisions. The procedure is delayed until three to seven days after the injury to allow swelling to subside, which ensures accurate repositioning.
Closed reduction is performed under local anesthesia, sometimes with sedation, or under general anesthesia. Instruments like an elevator or forceps are inserted into the nostril to lift and move the broken bone segments back into position. Following the reduction, an external splint or cast is applied to the nose for about one week to protect the repair and stabilize the bones.
Surgical Intervention for Complex Fractures
If a nasal fracture is severely crushed, involves multiple bone fragments, or presents with significant septal deviation, a complex surgical approach is necessary. These injuries require an Open Reduction, where a surgeon makes an incision to directly visualize and reconstruct the broken bone and cartilage. This allows for the use of sutures or grafts to stabilize the fragments, which is not possible with the closed technique.
If the nasal septum is severely fractured or deviated, a septoplasty may be performed to straighten the structure and restore clear breathing. If treatment occurs more than two weeks after the injury, the bone fragments may have already started to heal in the misaligned position. In this delayed scenario, a formal rhinoplasty, often combined with a septoplasty (septorhinoplasty), is required to reshape the nose and correct the deformity. Following surgery, patients must avoid contact sports and activities that could re-injure the nose for at least six weeks to ensure proper healing.