What is a broken 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 are known as the upper lateral cartilages, found in the middle third, and the lower lateral cartilages (tip cartilages) that form the tip of the nose.
Any time there is damage to any of these structures, it may be referred to as a broken nose.
What are the 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 signs & 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. 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 nasal septum deviation in the middle portion of the nose. Deviated septum symptoms are typically mild but can include nasal obstructions, nosebleeds, and noisy breathing during sleep.
- 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: Your nose may feel tender, especially to the touch.
What are the risk factors for a Broken Nose?
The primary risk factors leading to a fractured nose are primarily as simple as participation in events that may result in impact to the nose and face, including contact sports, physical altercations, or motor vehicle accidents.
How is a Broken Nose diagnosed?
Diagnosis of a broken nose is usually made by physical examination. It is typically quite easy for a doctor to be able to diagnose this issue without an X-ray evaluation being required.
What first aid/home treatments should I use for a Broken Nose?
A bag of ice or frozen peas across the nose as well as head elevation can reduce swelling. To stop bleeding, apply constant pressure to the nose with a thumb and forefinger for at least 15 minutes without letting go. Decongestant drops inside the nose like oxymetazoline may also help to decrease or stop bleeding. Tylenol (acetaminophen) is the only OTC pain medication that should be used, as non-steroidal pain medicines like Advil/Motrin (ibuprofen), aspirin, and Aleve (naproxen) can increase bleeding.
How is a Broken Nose treated?
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 broken nose 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/Internal Fixation: 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.
At the same time as an open reduction, other complementary 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.
What is the recovery/followup like for Broken Nose Surgery?
Depending on the type of surgery you have, you will likely have nasal packing/splints in your nose. These are placed 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, it is typically recommended that you take a minimum of 3 days off before returning to work. You should also avoid any heavy lifting in the immediate aftermath of surgery 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. You will be provided with pain medications, ointments, and nasal sprays to help maximize your results.
You will see your doctor for a follow-up appointment one week after surgery, during which they 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, your doctor will re-apply tape to the nose that will remain in place until your second postoperative visit. This pressure dressing reduces the amount of swelling. The second postoperative visit will involve removing the tape.
Your doctor will see you again in a follow-up appointment two weeks later, and another visit one month after that.
When should I see a doctor for a Broken Nose?
If the nose looks about the same and your breathing is fine then you may not need to see a doctor. If you lost consciousness, have other severe injuries, have a mental status change, or won’t stop bleeding, then you should seek emergency care. For all others like those with difficulty breathing or a change in the shape of the nose, it is important to see a doctor as soon as possible after the injury occurs. The best time to evaluate a broken nose is in the first 24 hours or after the swelling goes down at day 3 or 4. It is best to see an ENT doctor as they can diagnose and treat the condition at the same time.
Are there preventative steps or measures to avoid a Sinus Infection?
Accidents will happen, but you can significantly reduce your risk of nasal injuries by avoiding high-impact physical situations and using any relevant protective equipment like helmets or seatbelts when called for.
What are the risks if a Broken Nose is left untreated?
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, orbit, or skull) or eye. 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.
Is Broken Nose Surgery covered by health insurance?
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
Peleman, J. R., Chung, M. T., Johnson, J., Rayess, H., Priest, C. R., Hojjat, H., Mourad, M., Carron, M. A., & Vasconez, H. C. (2020). Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach. Aesthetic plastic surgery, 10.1007/s00266-020-01744-9. Link to Article.