Broken nose

Overview

A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose — often the bone over the bridge of your nose.

Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in injuries to the face.

A broken nose can cause pain, and it is common to get a nosebleed. You may have swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing through it.

Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary.

Symptoms

Signs and symptoms of a broken nose include:

• Pain or tenderness, especially when touching your nose
• Swelling of your nose and surrounding areas
• Bleeding from your nose
• Bruising around your nose or eyes
• Crooked or misshapen nose
• Difficulty breathing through your nose
• Discharge of mucus from your nose
• Feeling that one or both of your nasal passages are blocked

When to see a doctor

Seek emergency medical attention if you experience a nose injury accompanied by:

• A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness
• Difficulty breathing
• Bleeding you can't stop
• A noticeable change in the shape of your nose that isn't related to swelling, such as a crooked or twisted appearance
• Clear, watery fluid draining from your nose

Causes

Common causes of a broken nose include:

• Injury from contact sports, such as football or hockey
• Physical fights
• Motor vehicle accidents
• Falls

A broken nose can even be caused by walking into a fixed object, such as a door or wall, or by rough, wrestling-type play.

Risk factors

Any activity that increases your risk of injuries to the face can increase your risk of a broken nose. Such activities may include:

• Playing contact sports, such as football and hockey, especially without a helmet that has a face mask
• Engaging in a physical fight
• Riding a bicycle
• Lifting weights, especially if you don't use a spotter
• Riding in a motor vehicle, especially without a seat belt

Complications

Complications or injuries related to a broken nose may include:

• Deviated septum. A nose fracture may cause a deviated septum. This condition occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced, narrowing your nasal passage. Medications, such as decongestants and antihistamines, can help you manage a deviated septum. Surgery is required to correct the condition.
• Collection of blood. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils. It requires prompt surgical drainage to prevent cartilage damage.
• Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you also may experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgeon should address both your bone and cartilage injuries.
• Neck injury. If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck. If you suspect a neck injury, seek medical care immediately.

Prevention

You can help prevent a nose fracture with these guidelines:

• Wear your seat belt when traveling in a motorized vehicle, and keep children restrained in age-appropriate child safety seats.
• Wear the recommended safety equipment, such as a helmet with a face mask, when playing hockey, football or other contact sports.
• Wear a helmet during bicycle or motorcycle rides.

Diagnosis

Your health care provider may press gently on the outside of your nose and its surrounding areas. He or she may look inside your nasal passage to check for obstruction and further signs of broken bones.

You may receive numbing medication to make your nose more comfortable during the exam.

X-rays and other imaging studies are usually unnecessary. However, a computerized tomography (CT) scan may be ordered if the severity of your injuries makes a thorough physical exam impossible or if your provider suspects you may have other injuries.

Treatment

If you have a minor fracture that hasn't caused your nose to become crooked or otherwise misshapen, you may not need professional medical treatment. You may be fine just using ice on the area and taking over-the-counter pain medications.

Manual realignment

If the break has displaced the bones and cartilage in your nose, your health care provider may be able to manually realign them. This needs to be done within 14 days from when the fracture occurred, preferably sooner.

During this procedure, medication will numb your nose. In some cases, health care providers can push the nose back in place with their fingers. Sometimes, they may need to use special tools to help realign the broken bones and cartilage.

Your nose may be splinted with packing on the inside and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. If used, the packing usually needs to stay in for a week. The dressing may stay on for up to two weeks.

You may also be given a prescription for antibiotics to prevent infection from the bacteria that live in your nose.

Surgery

Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may need surgery. Surgery can realign the bones and reshape your nose, if necessary.

If the break has damaged your nasal septum — the middle part of your nose that divides your nostril — your breathing may feel blocked or you may feel like you have a stuffy nose. Reconstructive surgery may be recommended.

Self care

If you think you may have broken your nose, take these steps to reduce pain and swelling:

• Act quickly. When the break first occurs, breathe through your mouth and lean forward to reduce the amount of blood that drains into your throat.
• Use ice. Apply ice packs or cold compresses immediately after the injury, and then at least four times a day for the first 24 to 48 hours to reduce swelling. Keep the ice or cold compress on for 10 to 15 minutes at a time. Wrap the ice in a washcloth to prevent frostbite. Try not to apply too much pressure, which can cause additional pain or damage to your nose.
• Relieve pain. Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), as necessary.
• Keep your head up. Elevate your head — especially when sleeping — so as not to worsen swelling and throbbing.
• Limit your activities. For the first two weeks after treatment, don't play any sports. Avoid contact sports for at least six weeks after your injury.

Preparing for your appointment

If your injury is severe, you won't have time to prepare for your appointment because you'll need to seek immediate medical attention.

If the injury to your nose is less severe — accompanied only by swelling and moderate pain — you may choose to wait before seeking care. This allows time for the swelling to subside, making it easier to evaluate your injury.

However, it's best not to wait longer than 3 to 5 days before seeing your health care provider if your signs and symptoms persist. During this waiting period, get medical attention if:

• The pain or swelling doesn't progressively improve
• Your nose looks misshapen or crooked after the swelling recedes
• You can't breathe well through your nose even after the swelling subsides
• You experience frequent, recurring nosebleeds
• You're running a fever

When you make an appointment, you may start by seeing your primary care provider. He or she may refer you to a specialist in disorders of the ear, nose and throat.

Here's some information to help you get ready for your appointment, and to know what to expect.

What you can do

• Write down any symptoms you're experiencing and what you were doing at the time of the injury.
• Make a list of all medications, vitamins, and supplements you're taking.
• Bring a photo of yourself before the injury for comparison, if possible.
• Write down questions to ask.

Preparing a list of questions can help you make the most of your time with your health care provider. For a broken nose, here are some basic questions to ask:

• Do I need any tests, such as X-rays?
• How long will the swelling and bruising last?
• Will my nose look the same?
• Do I need surgery?
• Do I need to restrict my activity?
• What type of pain medication can I take?
• Are there any brochures or other printed materials that I can take home? What websites do you recommend for additional information?

What to expect from your doctor

Your health care provider may ask:

• How and when did your injury occur?
• Have your symptoms improved at all since the time of the injury?
• Does your nose look the same or different to you?
• Can you easily breathe through your nose?
• Do you participate in contact sports? If so, how long do you plan on participating in this sport?