Broken Nose (Nasal Fracture)

A nasal fracture is a break in the paired nasal bones at the top of the nose, often with damage to the cartilage and the septum, the wall that divides the nostrils. It is the most common facial fracture, because the nose is prominent and its bones are thin. Most are caused by a direct blow in sport, a fall or an assault.

Many broken noses are undisplaced and heal by themselves. If the nose has been pushed to one side or flattened, it can be manipulated back into place, but timing matters: either within the first few hours, before swelling develops, or at about 5 to 14 days, once swelling has gone down and before the bones set. After roughly 2 to 3 weeks in adults the bones have healed, and any correction means a formal septorhinoplasty several months later.

Symptoms

• Pain, swelling and tenderness over the bridge of the nose
• A crooked, flattened or widened nose
• Nosebleed at the time of injury
• Bruising around the eyes
• A blocked nose on one or both sides
• A crunching feeling when the nose is touched
• Reduced sense of smell

Causes and risk factors

Contact and ball sports, falls, fights and road accidents account for nearly all cases. A blow from the side displaces the bones sideways and is the usual pattern; a blow from the front needs more force and can crush the septum and extend into the bones around the eyes. Children's noses are more cartilage than bone, so fractures are less obvious, but septal injury still matters because it can affect nasal growth.

How it is diagnosed

• Clinical examination: Diagnosis rests on looking at and feeling the nose, ideally again at 5 to 7 days when swelling has settled.
• Inspection inside the nose: Essential to look for a septal haematoma, a soft, purple swelling of the septum that blocks the nose.
• Photographs from before the injury: Help to decide whether a deviation is new.
• X-rays: Plain nasal X-rays are generally unhelpful and do not change management.
• CT scan: Used only when other facial fractures, an orbital injury or a skull base injury are suspected.

Treatment options

• First aid: Lean forwards and pinch the soft part of the nose for bleeding; apply ice, keep the head raised and avoid blowing the nose.
• Observation: Undisplaced fractures need only pain relief and protection from further knocks for about 6 weeks.
• Closed reduction: Manipulation under local or short general anaesthetic within about 2 weeks, followed by a splint for about a week. A proportion of patients still want a later rhinoplasty.
• Drainage of a septal haematoma: An urgent minor procedure with packing and antibiotics, to prevent cartilage death and a saddle-shaped collapse.
• Septoplasty or septorhinoplasty: Performed from about 3 to 6 months after injury for persistent deviation, a collapsed bridge or a blocked airway.
• Treatment of wounds and open fractures: Cleaning, closure and antibiotics where the skin is broken.

When it is urgent

Seek emergency care locally for a nosebleed that does not stop after 15 to 20 minutes of firm pressure, clear watery fluid running from the nose, a nose completely blocked by swelling inside (possible septal haematoma), double vision or reduced vision, loss of consciousness, severe headache or neck pain, or an injury in a young child.

Travelling to Türkiye for treatment

A fresh fracture is assessed and, if needed, reduced locally, since the useful window is only about 2 weeks. People travel later, for correction of a nose that healed crooked or blocked. Post-traumatic septorhinoplasty is a planned operation, usually 1 night in hospital and 7 to 10 days on site until the splint comes off, and it is generally delayed until at least 3 to 6 months after the injury so that tissues have settled. Bring photographs from before the injury if you have them.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions