Overview

A broken nose, medically known as a nasal fracture, is a break or crack in the bones of the nose, most commonly the nasal bridge. It is one of the most common facial injuries due to the prominent and unprotected position of the nose. Nasal fractures can result from various causes, including sports injuries, falls, vehicle accidents, or physical altercations. While some nasal fractures are minor and heal without complications, others may lead to deformity, breathing difficulties, or require surgical correction. Prompt medical evaluation helps ensure proper healing and prevents long-term issues.

Causes

Broken noses typically result from trauma to the face. Common causes include:

• Sports injuries: Contact sports such as boxing, football, hockey, or martial arts are common culprits.
• Falls: Accidental falls, particularly in elderly individuals or during high-impact activities, can lead to nasal fractures.
• Physical assaults: Blunt force trauma from punches or assaults often involves nasal injury.
• Motor vehicle accidents: Car or motorcycle accidents can cause significant facial trauma, including nasal fractures.
• Accidental impacts: Colliding with doors, walls, or hard objects can also lead to a broken nose.

Symptoms

The symptoms of a broken nose can vary in severity depending on the extent of the injury. Common signs and symptoms include:

• Pain and tenderness: Immediate pain at the site of injury is typical.
• Swelling: Swelling around the nose and under the eyes often develops quickly after the injury.
• Bruising: Bruising around the nose and eyes, commonly known as “black eyes.”
• Deformity: A visible change in the shape or alignment of the nose, sometimes with a crooked or flattened appearance.
• Nosebleed: Bleeding from the nostrils is common following nasal fractures.
• Difficulty breathing: Blockage or obstruction of nasal passages may occur due to swelling or displacement of bones and cartilage.
• Crepitus: A crunching or crackling sound when touching or moving the nose, indicating fractured bone fragments.
• Clear nasal discharge: In severe cases, a clear fluid may leak from the nose, potentially indicating a cerebrospinal fluid (CSF) leak, which is a medical emergency.

Diagnosis

Diagnosis of a broken nose involves a combination of physical examination and imaging studies:

• Medical history: A healthcare provider will ask about how the injury occurred and any symptoms experienced.
• Physical examination: The doctor will inspect the nose for deformity, swelling, and tenderness, and check nasal airway patency.
• X-rays: While not always necessary, X-rays may be used to confirm fractures, especially in complex injuries.
• CT scan: In cases of severe trauma or suspected facial fractures beyond the nose, a CT scan provides a more detailed assessment.
• Nasal endoscopy: Occasionally, an endoscope may be used to examine internal nasal structures, especially if septal hematoma (blood clot in the septum) is suspected.

Treatment

Treatment for a broken nose depends on the severity of the fracture and associated symptoms. Management includes both immediate first aid and professional medical care:

• First aid:
  • Apply ice packs to reduce swelling and pain during the first 24-48 hours.
  • Keep the head elevated to minimize swelling and prevent further bleeding.
  • Avoid blowing the nose, which can worsen swelling or lead to complications.
• Medical treatment:
  • Pain relief using analgesics like acetaminophen or ibuprofen.
  • Nasal packing or dressing to control bleeding.
  • Closed reduction (manual realignment) of nasal bones, usually performed within 1 to 2 weeks after injury before bones set improperly.
• Surgical intervention: For severe fractures, septal damage, or significant cosmetic deformity, surgery such as septorhinoplasty may be required to restore function and appearance.
• Treatment of complications: Septal hematomas need urgent drainage to prevent cartilage damage, and antibiotics may be prescribed to prevent infection.

Prognosis

The prognosis for a broken nose is generally good with timely and appropriate treatment:

• Complete recovery: Most simple nasal fractures heal well within 3-6 weeks with proper care.
• Persistent deformity: Without proper alignment, cosmetic deformities or breathing difficulties may persist, requiring surgical correction.
• Low complication rates: Complications like chronic nasal obstruction, infection, or persistent cosmetic concerns are relatively uncommon with early treatment.
• Good functional outcome: With appropriate treatment, most individuals regain full nasal function and a satisfactory cosmetic result.

Early evaluation and treatment by a healthcare professional are key to preventing long-term issues and ensuring the best possible recovery from a broken nose.