NOSE FRACTURE

Nose fracture, medically termed nasal fracture, occurs when the bone or cartilage in the nose is broken. This can happen due to various reasons, ranging from accidents and sports injuries to physical altercations.

Recognizing a broken nose can sometimes be uncertain, so it’s advisable to seek medical attention if there’s any doubt. Early evaluation can help prevent potential complications.

Causes of Nose fracture

A broken nose can result from various causes, including:

Car accidents
Sporting events, especially contact sports like football
Fistfights or altercations
Falls
Accidentally running into objects like doors

Prevalence

Nose fractures are quite common, with millions of cases reported globally each year.
They are frequently encountered in emergency departments, especially during sports seasons or periods of increased physical activity.

Symptoms of Nose fracture

Symptoms of a broken nose include:

Swelling, bending, or crooked appearance of the nose
Pain, especially upon touching the nose
Nosebleed
Bruising or black eyes under the eyes
Difficulty breathing through the nose, feeling congested or blocked
Mucus discharge from the nose
Audible “cracking” sound when touching the nose

Immediately after injury, it’s essential to address bleeding and minimize pain and swelling. Here are some initial steps to take until you can see a doctor:

Risk Factors

Certain factors may increase the risk of experiencing a broken nose:

Participation in contact sports, particularly if the helmet lacks a face mask
Cycling
Weightlifting
Riding in motor vehicles without wearing a seat belt

Diagnosis

To diagnose a broken nose, your doctor will typically perform the following steps:

Ask about the circumstances surrounding the injury.
Apply gentle pressure to the outside of your nose and surrounding area.
Examine the inside of your nose for any signs of injury.
Check for bruising, cuts, or swelling around the nose.
Assess your eyes, jaw, and teeth for any associated injuries.

X-rays and other imaging scans are not typically necessary for diagnosing a broken nose unless there are concerns about additional injuries. However, your doctor may recommend them based on their assessment.

First aid for nose fracture

When providing first aid for a broken nose, the following steps can help manage symptoms until medical attention is available:

Stop the bleeding:
- Sit upright to prevent blood from flowing into the throat.
- Lean forward and pinch the soft part of the nose firmly with the thumb and index finger for 5 minutes.
- If bleeding persists, repeat the pinching for an additional 10 minutes.
Ease the pain:
- Take over-the-counter pain medication, such as acetaminophen or ibuprofen, as directed.
- Sleep with the head elevated on extra pillows to minimize swelling.
Reduce swelling:
- Wrap an ice pack in a towel and apply it to the nose for 10 minutes, then remove for 10 minutes. Repeat this process.
- Avoid applying direct pressure to the nose with the ice pack to prevent further injury.
- Apply an ice pack or cold compress to the nose at least four times daily for the first two days following the injury.

These first aid measures can help alleviate discomfort and reduce swelling temporarily until professional medical evaluation and treatment are obtained.

Treatments

Treatment for a broken nose depends on the severity of the injury:

Manual realignment: If the nose can be realigned without surgery, the procedure is typically performed within 1 to 2 weeks of the injury. Pain medication is administered before the procedure. The doctor uses a speculum to open the nostrils and a special instrument to realign the broken bones and cartilage. Packing is placed inside the nose, and a dressing is applied externally to stabilize the nose while it heals. Antibiotics may be prescribed to prevent infection.
Surgery: Severe or untreated nasal fractures may require surgical intervention to realign the bones and reshape the nose if necessary. Pain medication is administered, and additional nasal surgery may be performed to address breathing problems. In many cases, patients can return home on the same day as the surgery, but recovery may involve staying home for about a week due to swelling and bruising.

Home Care Tips

Apply ice packs to the nasal area to reduce swelling and pain.
Avoid blowing the nose forcefully, as this can exacerbate bleeding and discomfort.
Keep the head elevated while sleeping to minimize swelling.
Use over-the-counter pain relievers as directed by a healthcare professional to manage pain and inflammation.

Prevention

Wear appropriate protective gear, such as helmets or face masks, during sports activities to minimize the risk of facial injuries.
Practice caution and awareness in environments where falls or accidents are more likely to occur.
Address any underlying medical conditions that may weaken the bones and increase susceptibility to fractures.

When to See a Doctor

If swelling and pain are moderate, you may opt to wait to see a doctor, as symptoms might improve over time.

However, it’s crucial to consult a doctor if:

Pain and swelling persist or worsen after 3 to 5 days.
Swelling resolves, but the nose appears crooked.
Breathing difficulties persist even after swelling improves.
Frequent nosebleeds occur.
Fever develops.

In emergency situations, seek immediate medical assistance if experiencing:

Severe headache, neck pain, vomiting, or loss of consciousness
Difficulty breathing
Uncontrollable bleeding
Clear, watery fluid drainage from the nose

Outlook/Prognosis

With prompt and appropriate treatment, most uncomplicated nose fractures heal well, and individuals can expect a good prognosis.
Follow-up care and adherence to post-treatment recommendations are crucial for optimizing recovery and minimizing the risk of complications.

Sources

American Academy of Otolaryngology-Head and Neck Surgery. (2021). Nasal Fractures.
Mayo Clinic. (2021). Nasal Fracture.
National Health Service (U.K.). Broken Nose.
Cleveland Clinic. Broken Nose.
ENT Health. Nasal Fractures.