Broken nose

Date Updated: 07/01/2020

Overview

A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose — often the bone over the bridge of your nose.

Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in facial trauma. A broken nose can cause pain, along with swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing.

Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary for a broken nose.

Symptoms

Signs and symptoms of a broken nose:

Pain or tenderness, especially when touching your nose
Swelling of your nose and surrounding areas
Bleeding from your nose
Bruising around your nose or eyes
Crooked or misshapen nose
Difficulty breathing through your nose
Discharge of mucus from your nose
Feeling that one or both of your nasal passages are blocked

When to see a doctor

Seek emergency medical attention if you experience a nose injury accompanied by:

A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness
Difficulty breathing
Bleeding you can't stop
A noticeable change in the shape of your nose that isn't related to swelling, such as a crooked or twisted appearance
Clear, watery fluid draining from your nose

Causes

Common causes of a broken nose include:

Injury from contact sports, such as football or hockey
Physical altercations
Motor vehicle accidents
Falls

A broken nose can even be caused by walking into a fixed object, such as a door or wall, or by rough, wrestling-type play.

Risk factors

Any activity that increases your risk of a facial injury increases your risk of a broken nose. Such activities may include:

Playing contact sports, such as football and hockey, especially without a helmet that has a face mask
Engaging in a physical fight
Riding a bicycle
Lifting weights, especially if you don't use a spotter
Riding in a motor vehicle, especially without a seat belt

Complications

Complications or injuries related to a broken nose may include:

Deviated septum. A nose fracture may cause a deviated septum, a condition that occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced, narrowing your nasal passage. Medications, such as decongestants and antihistamines, can help you manage a deviated septum, but surgery is required to correct the condition.
Collection of blood. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils. Septal hematoma requires prompt surgical drainage to prevent cartilage damage.
Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you also may experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgeon should address both your bone and cartilage injuries.

Prevention

You can help prevent a nose fracture with these guidelines:

Wear your seat belt when traveling in a motorized vehicle, and keep children restrained in age-appropriate child safety seats.
Wear the recommended safety equipment, such as a helmet with a face mask, when playing hockey, football or other contact sports.
Wear a helmet during bicycle or motorcycle rides.

Diagnosis

Your doctor may press gently on the outside of your nose and its surrounding areas. He or she may look inside your nasal passage to check for obstruction and further signs of broken bones. Your doctor may use anesthetics — either a nasal spray or local injections — to make you more comfortable during the exam.

X-rays and other imaging studies are usually unnecessary. However, your doctor may recommend a computerized tomography (CT) scan if the severity of your injuries makes a thorough physical exam impossible or if your doctor suspects you may have other injuries.

Treatment

If you have a minor fracture that hasn't caused your nose to become crooked or otherwise misshapen, you may not need professional medical treatment. Your doctor may recommend simple self-care measures, such as using ice on the area and taking over-the-counter pain medications.

Fixing displacements and breaks

Your doctor may be able to realign your nose manually, or you may need surgery.

Manual realignment

If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them. This needs to be done within 14 days from when the fracture occurred, preferably sooner.

During this procedure, your doctor:

Administers medication by injection or nasal spray to ease discomfort
Opens your nostrils with a nasal speculum
Uses special instruments to help realign your broken bones and cartilage

Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You'll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose.

Surgery

Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may not be candidates for manual realignment. In these cases, surgery to realign the bones and reshape your nose may be necessary.

If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis.

Lifestyle and home remedies

If you think you may have broken your nose, take these steps to reduce pain and swelling before seeing your doctor:

Act quickly. When the break first occurs, breathe through your mouth and lean forward to reduce the amount of blood that drains into your throat.
Use ice. Apply ice packs or cold compresses immediately after the injury, and then at least four times a day for the first 24 to 48 hours to reduce swelling. Keep the ice or cold compress on for 10 to 15 minutes at a time. Wrap the ice in a washcloth to prevent frostbite. Try not to apply too much pressure, which can cause additional pain or damage to your nose.
Relieve pain. Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), as necessary.
Keep your head up. Elevate your head — especially when sleeping — so as not to worsen swelling and throbbing.
Limit your activities. For the first two weeks after treatment, don't play any sports. Avoid contact sports for at least six weeks after your injury.

Preparing for an appointment

If your injury is severe, you'll need to seek immediate medical attention and won't have time to prepare for your appointment. But, if the injury to your nose is less severe — accompanied only by swelling and moderate pain — you may choose to wait before seeing your doctor. This allows time for the swelling to subside, so you and your doctor can better evaluate your injury.

However, it's best not to wait longer than three to five days before seeing your doctor if your signs and symptoms persist. And during this waiting period, get medical attention if:

The pain or swelling doesn't progressively improve
Your nose looks misshapen or crooked after the swelling recedes
You can't breathe efficiently through your nose even after the swelling subsides
You experience frequent, recurring nosebleeds
You're running a fever

When you make an appointment, you'll probably start by seeing your primary care doctor. However, he or she is likely to refer you to a doctor who specializes in disorders of the ear, nose and throat.

Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.

What you can do

Write down any symptoms you're experiencing, and let your doctor know what you were doing at the time of the injury.
Make a list of all medications, vitamins and supplements you're taking.
Bring a photo of yourself before the injury for comparison, if possible.
Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For a broken nose, some basic questions to ask your doctor include:

Do I need any tests, such as X-rays?
How long will the swelling and bruising last?
Will my nose look the same?
Do I need surgery?
Do I need to restrict my activity?
What type of pain medication can I take?
Are there any brochures or other printed material that I can take home? What websites do you recommend for additional information?

What to expect from your doctor

Your doctor may ask:

How and when did your injury occur?
Have your symptoms improved at all since the time of the injury?
Does your nose look normal to you?
Can you easily breathe through your nose?
Do you participate in contact sports? If so, how long do you plan on participating in this sport?