Nasal fracture, also known as a broken nose, is the most common type of facial fracture. This could be due in part to the fact that the nose is the most prominent of the facial features.
Anatomy of the nose
Nasal fracture is a term used to describe a break or crack in the nasal bones. The fracture usually occurs at the bridge of the nose where the two nasal bones join together.
The remainder of the nose, the septum, nostrils, and area below the bridge, is supported by cartilage, which extends from just below the bridge to the tip.
Causes of nasal fracture
Trauma to the bridge of the nose is responsible for most nasal fractures. Broken noses in adults often occur as a result of the following:
- Fist fights or altercations
- Sports injuries
- Motor vehicle accidents
Nasal fractures in children are usually due to sports injuries or accidents that occur during play. The injury may also be caused by physical abuse.
Symptoms of nasal fracture
Typical symptoms of nasal fracture include:
- Nose bleed
- Bruising around the nose or eye (black eye)
- Bent, crooked or misshapen nose
- Nasal stuffiness due to blocked nasal passages
- Difficulty breathing through the nose
- Crepitus (a crinkling or grating sound heard when the nose is moved)
Nasal fracture diagnosis
Most nasal fractures can be diagnosed through physical examination. A local anesthetic may be used to make the exam more comfortable. If injuries are extensive or pain is severe, CT (computerized tomography) may be used. In cases where there is a large amount of swelling, patients may be instructed to elevate the head and apply ice until swelling is reduced to ensure a more accurate diagnosis.
Complications of nasal fracture
Nasal fracture can occur with the following complications:
- Deviated nasal septum – the thin wall that divides the nasal passages can become damaged or displaced, making it difficult to breathe
- Septal hematoma – a pooling of blood that occurs within the nasal septum that can cause congestion, interfere with breathing and lead to serious infection. The condition is rare but requires surgical drainage
- Nasal cartilage damage – injury to the cartilage may need surgical repair
- Head and neck injury – head or neck injury can occur in conjunction with nasal fracture, if trauma was severe. Persistent drainage of clear fluid from the nose following nasal trauma could be cerebral spinal fluid, indicating brain injury
- Loss or impairment of sense of smell – reduced smell may occur with deviated septum or other nasal injuries
Nasal fracture treatment
Intermittent application of ice along with over-the-counter pain medications may be prescribed for the treatment of pain and swelling. This may be the only treatment needed in simple fractures with no dislocation or complications.
If the bone or cartilage requires adjustment, realignment may be done manually. Splints or nasal packing may be needed after the manual realignment. Manual realignment must be done within 14 days of the injury. It is important that the adjustment only be done by a qualified physician, never by the patient. Antibiotics may be prescribed to prevent infection.
More severe nasal fractures may require surgery to realign the nose or repair the septum