Broken Nose

Go to your doctor for a broken nose after the swelling is gone, usually about 3-5 days.

A broken nose is any crack or fracture in the bony portion of the nose. This is usually a result of external trauma. Blows to the face during altercations, vehicle accidents, falls, and sports injuries are the most common reasons for a fractured nose. Nasal fractures are often cited as the most common type of facial fracture, accounting for approximately half of all facial fractures in several studies.

A broken nose usually is obvious due to symptoms like bruising, swelling, and bleeding from the nose. A history of traumatic injury should lead to suspicion of a broken bone in the nose or nasal fracture.

Signs that suggest a person has a broken nose may include:

1. Tenderness when touching the nose
2. Swelling of the nose or face
3. Bruised nose
4. Bruising under the eyes (black eye)
5. Deformity of the nose (crooked nose)
6. Nosebleed
7. When touching the nose, a crunching or crackling sound (crepitus) or creaking sensation like that of rubbing hair between two fingers
8. Pain and difficulty breathing out of the nostrils

If a nasal injury is minor, further care may not be needed. Many will need a follow-up visit in about 3-7 days after the swelling has resolved. If a severe break has occurred, corrective surgery may be required.

Causes of a broken nose are related to trauma to the nose or face. Common sources of trauma include the following:

• The most common cause of a broken nose are fights, accidents, and sports. A 2009 study of 236 patients with facial fractures incurred while playing sports found fractures of the nasal bone to be the most common.
• Sports injuries
• Personal fights
• Motor vehicle accidents
• Falls
• In children, nasal fractures are most commonly due to falls.

Call the doctor if any you have any of these symptoms and signs of a broken nose.

• The pain or swelling does not go away in 3 days.
• The nose looks crooked.
• Breathing through the nose is not possible after the swelling has gone down.
• A fever develops.
• Recurring nosebleeds develop.
• A significant injury that requires medical attention possibly exists.

Go to a hospital's emergency department immediately if the following signs or symptoms are present:

• Bleeding for more than a few minutes from one or both of the nostrils
• Bleeding from the nose does not stop
• Clear fluid draining from the nose
• Other injuries to the face or the body
• Open laceration to the nose or the face
• Loss of consciousness (fainting)
• Severe or unrelenting headaches
• Repeated vomiting
• Decrease or change in vision
• Neck pain
• Numbness, tingling, or weakness in the arms
• A significant injury that may require immediate medical attention

In the emergency department, a doctor will examine the head, neck face, and nose.

• The doctor will inspect the outside and the inside of the nose, often using special instruments. Expect the examination to be somewhat painful.
• X-rays may be ordered depending on the clinical situation. X-ray films and blood work are not routinely used because these tests usually do not alter the course of treatment.
• CT scan of the head and face may be necessary with severe facial fractures.

Taking these actions at home may help reduce the symptoms of a broken nose.

• Place ice wrapped in a cloth over the nose for about 15 minutes at a time and then remove the ice. This process can be repeated hourly throughout the day. Use ice at the time of injury and for 1-2 days afterward to reduce pain and swelling. Take breaks between applications, and do not apply the ice directly to the skin. A bag of frozen peas or corn can be used as an ice pack as it will conform to the nose.
• Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain. Only use these medications as directed.
• Take an over-the-counter (OTC) nasal decongestant to aid in breathing through the nostrils.
  • Do not use OTC nasal decongestants if the nose continues to bleed. Seek medical care.
  • Read warning labels associated with these medications.
  • These medications should not be used for more than 3 days.
• Use ice regularly to reduce swelling and inflammation.
• Elevate the head, especially when sleeping, to avoid increased swelling of the nose. Prop the head up with pillows or lift the head of the bed by placing large blocks or phone books under the mattress.
• Avoid resting anything on the nose, including glasses and sunglasses.
• Do not attempt to straighten the nose.

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be recommended for pain. Follow the instructions on the medication bottle. Do not exceed the dose stated on the package instructions.
• For more serious injuries, stronger pain medication may be prescribed.
• Call a doctor or pharmacist if any questions or concerns arise regarding any medication.

• For simple breaks in which the nose has not been displaced (the bone is not crooked), the doctor may prescribe only pain medication, ice, and nasal decongestants.
• For markedly displaced fractures, the doctor may attempt to realign the bone pieces. The doctor may use pain medication, local anesthesia, and nasal instruments.
• Most repairs of nasal fractures are done after the swelling has subsided.
  • Not all displaced fractures can be relocated immediately.
  • Not all displaced fractures can be relocated in the emergency department. Some fractures may require an ear, nose, and throat physician (ENT, or otolaryngologist) for surgery.

If the nose continues to bleed, the doctor may insert packing into the nostrils.

• A soft gauze pad will be placed in the bleeding nostril and should stop the nosebleed completely. The doctor or ENT usually removes the packing in 2-3 days.
• Do not attempt to remove this packing.
• The doctor will sometimes prescribe antibiotics and pain medication while the packing is in place.
• If other injuries exist, additional diagnostic tests and treatment may be given.

Surgery may be needed for multiple breaks in the nose, persistent deformity (such as a deviated septum), or damage to the inner portions of the nose.

• Some simple surgeries can be performed in the doctor's office.
  • The doctor pushes the broken bones back into place.
  • Special instruments and pain medicine (anesthesia) may be used.
  • Anesthesia may be injected into the nose or placed in the nostrils.
• Other surgeries are performed in the operating room.
  • These surgeries tend to be more complex and involve realigning the nasal bones and surrounding tissue.
  • Intravenous (IV) anesthesia is often used.
• Simple fractures that are not out of place do not usually require surgery.
• A doctor will advise the best treatment plan.

About 3-5 days after the swelling in the nose has gone away, a person may be referred to an ear, nose, and throat (ENT) doctor, an oral and maxillofacial surgeon (OMFS), or a plastic surgeon.

Follow-up care should not be delayed. A delay, especially longer than 7-10 days, may cause a broken bone to be set in a deformed state.

• Avoid drug and alcohol use. Many nose breaks occur during or after the abuse of these drugs.
• Follow safety rules when participating in sports and physical recreation.
• Wear a seatbelt at all times while riding in a motor vehicle.
• Make sure children are in an approved car seat when riding in a vehicle.