What is a broken nose?
A broken nose refers to any time there is damage to the structure of the nose. The nose is made up of:
Nasal Bones: There are two bones at the top of the nose. These bones come together to form a pyramid shape at the top 1/3rd of the nose.
Cartilage: There are 5 cartilages that form the middle and lower thirds of the nose. These refer to the upper lateral cartilages, found in the middle third, and the lower lateral cartilages, or “tip cartilages,” that form the tip of the nose.
Any time there is damage to any of these structures, then it may be referred to as a broken nose.
What are the symptoms of a broken nose?
Depending on the location of the broken nose, you may experience different symptoms. The most common symptom would be a noticeable deformity involving the nasal bones and/or cartilages. Some nasal deformities which may be caused by a broken nose include:
- Open Roof Deformity: This refers to “splaying” of the nasal bones. As seen in the diagram below, the bones that form the top third of the nose should form a pyramid structure, coming together in the middle of the nose. If you break your nose, in a way that makes the bones no longer come together properly, you form ridges on the top of the nose. These ridges are the edges of the nasal bones that no longer come together properly.
- Deviated Nose (Bridge): Sometimes the axis of the nose may be deviated, skewing to one side. This can refer to a fracture in the nasal bones, or nasal cartilages.
- Deviated Nose (Septum): If the nasal fracture involves the nasal septum, you may notice a deviation in the middle portion of the nose.
- Saddle Nose: This type of fracture refers to a break in the septum. This will result in a sagging or collapse of the middle portion of the nose, referred to as a saddling.
Other symptoms of a broken nose include:
- Bleeding and/or bruising: Particularly during the course of breaking your nose, you may experience bleeding from one or both sides of the nose. You may also experience bruising in the cheeks and around the eyes (sometimes referred to as “raccoon eyes”).
- Nasal Airway Obstruction: Any break in the structure of the nose may also alter your ability to breathe through your nasal passages. You may experience a decrease or absence in your nasal breathing. This may be particularly evident during broken noses that cause shifting, or breakage of the nasal septum.
- Nasal Pain: You may experience tenderness of the nose
What are the risk factors/causes of a broken nose?
The most common risk factor for a broken nose is nasal trauma. Any time you hit your nose, directly or indirectly, there is potential for a break to develop. Participation in any activity that involves the potential of hitting your nose is a risk factor. Contact sports (e.g. football), weight lifting, motor vehicle accidents, bike riding, or physical altercations may all put you at increased risk of a broken nose.
Many broken noses go undiagnosed. If you have experienced trauma to your nose at any point in your life where there was a direct impact to your nose, there is a possibility that you may have broken your nose. It is crucial to disclose all nasal trauma history to your surgeon.
What are the complications or related injuries associated with a broken nose?
If you break your nose, it is important that you have a full and thorough evaluation by a specialist. Because of the trauma associated with breaking your nose, it is not uncommon that other injuries occur at the same time, such as head/brain injuries or fractures involving the facial bones (jaw, cheeks, or skull) or eye (or orbit). Other complications which may occur as a consequence of a broken nose include:
- Septal Hematoma: This refers to a collection of blood inside the nasal septum that leads to a septal perforation.
- Deviated Septum: This refers to a movement or shifting of the nasal septum.
What is the surgery for fixing a broken nose?
Broken noses are usually corrected through surgery. The type of surgery that best suits you will depend on the timing of the nasal fracture, as well as the complexity of the fracture. There are two types of surgery:
- Closed Reduction: This type of surgery is performed up to 7 days following the nasal fracture. Prior to the 8th day, the bones still have not fused, and can be manipulated and pushed back into place using external pressure. This can be performed in the office and under local anesthesia. This type of surgery only works with simple fractures that involve the bones. It does not address alterations to the nasal airway such as a deviated/fractured septum.
- Open Reduction: This type of surgery is performed beyond the 8 day mark after the injury has been sustained. After 8 days, the bones have already begun to heal, and in order to correct the deformity, the nasal bones need to be rebroken in a procedure known as an osteotomy. By breaking the nose in a controlled fashion, the nasal structure can be restored to its natural position.
Af the same time as an open reduction, other complimentary surgeries can also be performed to address any issues that have resulted from the nasal trauma:
Septoplasty: During the same surgery as the open reduction, the septum can be placed in the midline correcting any obstruction to the nasal airway.
Nasal Valve Surgery: The nasal valves may also be damaged or weakened as a result of nasal trauma. Correction of the valves can also be addressed at the same time as reduction of the nasal valve surgery.
After broken nose surgery recovery
Depending on the type of surgery you have, you will likely have nasal packing/splints in your nose. These are placed by Dr. Mourad to allow for proper healing of the internal nasal structures, like an “internal cast” for the nose. These are typically removed at your first postoperative visit, one week after surgery. You will also likely have a nasal cast on the outside of the nose. This helps to reduce swelling and keep everything in place. This will also remain on the nose for one week following surgery.
Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting as this can alter the structure of the nose through straining. If you wear glasses, you may require some alterations to avoid putting pressure on the nasal bones. Dr. Mourad will provide you with pain medications, ointments, and nasal sprays to help maximize your results.
You will see Dr. Mourad one week after surgery where he will remove all casting materials and splints. Your nose may be swollen for a temporary period of time, but this should not be cause for alarm. The nose is a small area, and all that surgery causes swelling that eventually decreases with time. Depending on the patient, this swelling typically lasts for 2-3 weeks, but it can last up to two months in rare circumstances. To help reduce swelling, Dr. Mourad will re-apply tape to the nose that will remain in place until your second post-operative visit. This pressure dressing reduces the amount of swelling. The second postoperative visit will involve removing the tape.
Dr. Mourad will see you again in a follow-up appointment two weeks later, and another visit one month after that. Dr. Mourad enjoys building relationships with his patients and will often continue with follow-up visits for many years following the initial surgery.
Will my insurance cover broken nose surgery?
Since breaking your nose constitutes a significant compromise to your health, it is typically covered by insurance. This becomes particularly important if the broken nose has caused a detriment to your ability to breathe that has impacted your quality of life.
Select Relevant Publications
Moustafa Mourad, Jared C. Inman, David M. Chan, Yadranko Ducic. Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks. Cranial Maxillofac Trauma Reconstruction. 2018; 11(01): 071-077. Link to Article.