Nasal fracture

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 29, 2016
StartDiseasesNasal fracture

Nasal fractures are a common occurrence in people of all ages. These fractures are easily diagnosed, and in most cases, treatment is quick and simple. However, nasal fractures are still a painful and potentially serious injury, so people who believe they may have a fracture should seek medical help quickly.

Contents

Definition & Facts

A nasal fracture is a break in one of the bones in the nose, usually in the bridge of the nose. Nasal fractures also often result in damage to the surrounding cartilage, especially in the nasal septum, which separates the right and left halves of the nose. Because nasal bones are more fragile than most other bones, nasal fractures are very common in both teenagers and adults, and they make up about 40 percent of all facial injuries.

Symptoms & Complaints

Symptoms of a nasal fracture vary depending on the location and severity of the break, but some of the most common symptoms include nose pain and bruising in the nose, blocked nasal passages, swelling, and a crooked appearance of the nose.

Sometimes, injured individuals will see bruising or discoloration under their eyes as a result of a broken nose. Nosebleeds and discharge of mucus from the nose are also common symptoms. In some cases, nasal fractures can result in a deviated septum, which occurs when the septum is displaced to one side.

More serious signs of a severe nasal fracture include difficulty breathing, unstoppable bleeding, a hole in the septum, and a loss or change in sense of smell (anosmia). A clear change in the appearance of the nose unrelated to swelling can also be a sign of a severe nasal fracture.

Causes

Nasal fractures are caused by any sort of impact or trauma to the nose or face. In teenagers and young to middle-aged adults, sports, fights, and car accidents are the three most common causes of broken noses.

Many people experience nasal fractures as a result of playing contact sports, especially sports like wrestling and boxing. Contact sports like football and hockey often result in nasal fractures as well, but the risk of a fracture when wearing a proper helmet is low.

Some people receive fractures during physical fights. Car accidents are another common cause of nasal fractures, but airbag improvements and increased use of seat belts over time has greatly reduced the number of people who break their noses in accidents. Sometimes, people sustain nasal fractures from walking into structures like doors and walls.

In young children and the elderly, falls are the most common cause. In the elderly, falls often occur as a result of impaired balance, syncope, or fainting. Infants sometimes experience nasal fractures during delivery. In general, however, younger children are at less of a risk for broken noses than adults because of their more flexible bones.

Diagnosis & Tests

Doctors usually diagnose nasal fractures by performing a physical examination. The doctor will review the patient's symptoms and the cause of the fracture before examining the nose. If the patient is in serious pain, the doctor may use a local anesthetic to numb the area before touching it.

Then, the doctor will observe the nose's shape, symmetry, and alignment as well as any bruising or swelling. They will also look at the septum's positioning, and they sometimes use a nasal speculum to spread open the nostril to look for any blood clots or bruises. In most cases, doctors are able to diagnose a broken nose without any further testing.

X-rays are often unhelpful for diagnosing simple fractures in the bones of the nose, but if the doctor suspects that the septum or other facial bones are damaged, they may send the patient for an X-ray or a CT scan.

If the nose is deformed or the patient has trouble breathing because of a deformed air passage, the doctor may send the patient to an otolaryngologist for specialized testing and treatment. If the fracture is not severe and the patient shows no serious symptoms, the doctor may wait two or three days until the swelling has gone down to examine and diagnose the fracture. 

Treatment & Therapy

Injured individuals who are not experiencing severe pain or other symptoms may wait a day or two before going to the doctor. In this case, they should apply ice to the fractured area and take ibuprofen if possible for pain relief. They should keep their head elevated to reduce pain.

Minor fractures may be able to heal on their own, but if the fracture has caused displacement of the bones or septum, a doctor will need to realign the bones either manually or with surgery. During a manual realignment procedure, the doctor will administer a numbing medication to the area, open the nostril with a nasal speculum, and use small instruments to realign the bones. After the procedure, the doctor will apply a splint and a dressing to the outside of the nose that should remain for about a week.

A surgical realignment procedure may be needed for severe fractures, multiple fractures, or fractures that have been untreated for more than two weeks. If the nose is severely deformed or misaligned, the patient may need rhinoplasty, a surgery to realign the nose, or septorhinoplasty, a surgery to repair and realign the septum. Doctors may prescribe pain medication after the procedure, and the pain should start to subside after about three days.

Prevention & Prophylaxis

Nasal fractures can be prevented simply by avoiding trauma to the nose and taking safety precautions in their day-to-day life. Wearing sturdy shoes to prevent falling, wearing a helmet while riding a bike or a motorcycle, and wearing protective head and face gear during contact sports are all precautions that can greatly reduce the risk of a broken nose.

Wearing a seatbelt in the car can also prevent nasal fractures in the event of an accident. To avoid fractures, people should always be aware of their surroundings, especially when in a situation where trauma to the nose may occur. Parents of young children and caretakers of the elderly should take safety precautions to minimize the risk of tripping and falling.