NOSE FRACTURE

Symptoms of a broken nose include:

• Nose pain.
• Swelling of the nose.
• Bleeding from the nose.
• A crooked or bent appearance.
• Bruising around the nose or eyes.
• A grating sound or feeling when the nose is touched or rubbed.
• Blocked nasal passages.

Possible complications of a broken nose include:

• Change in the appearance of the nose or the tip of the nose.
• A large amount of blood in the nasal septum (nasal septal hematoma).
• A hole in the nasal septum (septal perforation) or causing the bridge of the nose to collapse (saddle nose deformity).
• Crooked (deviated) nasal septum. The nasal septum is the structure that divides the nose into two parts. See a picture of a deviated nasal septum camera.gif.
• Permanent breathing difficulty.
• Persistent drainage from one or both nostrils. This may be caused by cerebrospinal fluid draining from the brain into the nose (CSF rhinorrhea) and can occur after a head injury or after surgery on the nose or ears.
• Infection of the nose, sinuses, or facial bones.
• A change in or loss of sense of smell.

DIAGNOSIS

A broken nose is diagnosed through a physical exam and medical history. An X-ray of the nose may be done. If other facial injuries or fractures are suspected, a CT scan will be done. Your doctor may wish to delay evaluation until the swelling has gone down. This may take several days.

RECOMMENDED MEDICATIONS

Immediately after the fracture, apply ice and keep your head elevated. You may need pain medicine, such as acetaminophen (for example, Tylenol). Be safe with medicines. Read and follow all instructions on the label. Do not take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) or aspirin, for 48 hours after a nose injury. Do not take aspirin if you are younger than 20 because of the risk of Reye syndrome.

Immediate treatment is needed for some injuries that occur with a broken nose, such as:

• A large amount of blood in the nasal septum (nasal septal hematoma).
• A nosebleed that you cannot stop (epistaxis).
• Clear drainage from one or both nostrils (CSF rhinorrhea).

Fixing displacements and breaks

Your doctor may be able to realign your nose manually, or you may need surgery.

Manual realignment

If the break has displaced the bones and cartilage in your nose, your doctor 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, your doctor:

• Administers medication by injection or nasal spray to ease discomfort
• Opens your nostrils with a nasal speculum
• Uses special instruments to help realign your broken bones and cartilage

Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You’ll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose.

Surgery

Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may not be candidates for manual realignment. In these cases, surgery to realign the bones and reshape your nose may be necessary.

If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis.