A broken nose, or nasal fracture, involves a crack or break in the bone or cartilage structure of the nose. This common facial injury usually results from direct trauma, such as a fall, impact during contact sports, or a motor vehicle accident. The fracture can affect the two small bones forming the bridge, the surrounding cartilage, or the septum, which divides the nostrils. Knowing the immediate steps and professional treatment options is important for proper healing and preserving the nose’s appearance and function.
Immediate Care and Emergency Warning Signs
The first priority following a nasal injury is managing bleeding and controlling swelling. If bleeding occurs, the injured person should sit upright and lean slightly forward. This encourages blood to drain out of the nose instead of down the throat, preventing nausea or vomiting. Pinching the soft, fleshy part of the nose just above the nostrils for 10 to 15 continuous minutes helps stop the flow of blood.
Once bleeding is controlled, apply a cold compress or an ice pack wrapped in a cloth to the nose for 10 to 15 minutes at a time to reduce swelling and pain. Over-the-counter pain relievers like acetaminophen can manage discomfort. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen initially, as they can increase bleeding. Keeping the head elevated, even while resting, also minimizes swelling by promoting fluid drainage.
Certain symptoms require immediate emergency medical attention, as they may indicate a more severe underlying injury. A clear, watery fluid continuously draining from the nose or ears can signal a cerebrospinal fluid (CSF) leak, suggesting a fracture at the base of the skull. Difficulty breathing that does not improve after initial swelling reduction also warrants an emergency room visit. Evaluation is necessary if a purple or dark red swelling is visible inside the nose on the septum, which may be a septal hematoma that can damage cartilage if not drained promptly.
Clinical Diagnosis and Non-Surgical Treatment
A healthcare professional typically diagnoses a nasal fracture through a physical examination, often without imaging tests like X-rays or CT scans. The doctor inspects the nose and gently palpates the area to identify irregularities, bone movement, or a grating sensation known as crepitus. Imaging is usually reserved for cases involving other suspected facial injuries or when a complex fracture pattern is anticipated.
The most common non-surgical treatment for a displaced fracture is closed reduction, which involves manually manipulating the broken bones back into their correct position. This procedure is performed after initial swelling subsides, ideally between five and fourteen days after the injury. The timing is important because if performed too early, swelling can obscure the true alignment, and if performed too late, the bones may be too consolidated to move without surgery.
During a closed reduction, the patient receives local anesthesia to numb the area, and sometimes mild sedation for comfort. The practitioner uses specialized instruments to carefully align the fractured bones without an external incision. If the fracture is severe or delayed past the two-week window, the injury may require an open reduction, which is a surgical procedure often combined with a septorhinoplasty to address complex issues.
Non-displaced fractures, where the bones are cracked but remain aligned, do not require reduction. These are managed conservatively with pain control and protective measures.
Recovery Timeline and Aftercare Instructions
Following either conservative management or a closed reduction, the recovery period focuses on stabilizing the nose and preventing further trauma. Swelling is expected to decrease within the first three to five days, though bruising around the eyes, sometimes called “raccoon eyes,” may take two to three weeks to fully resolve. The nasal bones themselves require approximately three to six weeks to achieve stability.
If a closed reduction was performed, the doctor may place external splints and internal packing to maintain the new bone position. This is typically removed about one week after the procedure. Patients must avoid getting the external splint wet to ensure it remains securely attached to the nose.
Patients must avoid activities that increase pressure in the head for several weeks, including blowing the nose forcefully, heavy lifting, or straining. For at least six weeks, avoid contact sports and activities where the face could be struck to prevent re-injury. Patients should also refrain from wearing glasses that rest on the bridge of the nose until cleared by a doctor, as the pressure can shift the healing bones. Sleeping with the head elevated helps reduce residual swelling, and gentle saline nasal sprays can keep the nasal passages clean and moist after any packing is removed.