The bones of the nose are broken (fractured) more often than any other facial bone. When nasal bones break, the mucous membrane lining the nose usually tears, resulting in a nosebleed. Most commonly, the bridge of the nose is pushed to one side. Sometimes, the cartilage of the nasal septum can break. If blood collects under the mucous membrane that lines the cartilage of the nasal septum (septal hematoma), the cartilage may die. The dead cartilage may disintegrate, resulting in a saddle nose deformity, in which the bridge of the nose sags in the middle.
A person whose nose bleeds, hurts, and is swollen and tender after a blunt injury may have a broken nose. Applying ice packs every 2 hours for 15 minutes at a time, taking pain relievers (such as acetaminophen or ibuprofen), and sleeping with the head elevated help limit pain and swelling. However, medical attention is needed.
The mucous membrane and other soft tissues swell quickly, making the break difficult for a doctor to find, so the evaluation needs to be done either very quickly (within the first few hours) or later after the swelling has started to subside but before the bones become fixed in their new position. Ordinarily, a doctor diagnoses a broken nose by gently feeling the bridge of the nose for irregularities in shape and alignment, unusual movement of bones, the rough sensation of broken bones moving against one another, and tenderness. X-rays of the nose may not be as accurate as the doctor's eyes and fingers for determining proper bone alignment.
Doctors usually wait 3 to 5 days after an injury for the swelling to go down before they push the broken pieces of bone back into place (called reduction). Waiting makes it easier for doctors to see and feel when the pieces are perfectly aligned. Many nasal fractures are in a good position and do not have to be reduced.
First, doctors give adults a local anesthetic, which numbs the area. Children are given a general anesthetic, which causes temporary unconsciousness. Before reducing the fracture, any blood that has collected in the septum is drained through a small incision in the mucous membrane of the septum to prevent the destruction of the cartilage. By pressing with their fingers, doctors manipulate the bones into their normal position. The nose is then stabilized with an external splint. Internal packing (stenting) may also be used. Antibiotics are given while the packing is in place to decrease the risk of infection. Nasal bone fractures heal in about 6 weeks. Fractures of the septum are difficult to set and often require surgery later.
Last full review/revision October 2012 by Marvin P. Fried, MD