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Nasal fracture - aftercare

Broken nose

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Description

Your nose has 2 bones at the bridge and a long piece of cartilage (flexible but strong tissue) that gives your nose its shape.

A nasal fracture occurs when the bony part of your nose has been broken. Most broken noses are caused by trauma such as sport injuries, car accidents, or fights.

More About Your Injury

If your nose is crooked from the injury you may need a reduction in order to put the bones back in place. If the break is easy to fix, a reduction can be done in your health care provider's office. If the break is more severe, you may need surgery to fix it.

You may have a hard time breathing through your nose because the bones may be out of place or there is a lot of swelling.

What to Expect

You may have one or all of these symptoms of a broken nose:

• Swelling on the outside and on the bridge of your nose
• Pain
• A crooked shape to your nose
• Bleeding from either inside or outside your nose
• Difficulty breathing through your nose
• Bruising around one or both eyes

Although imaging, such as an x-ray, is often not necessary, in some cases your provider may need to get an x-ray to see if you have a fracture. A CT scan or other tests may be needed to rule out a more serious injury.

If you have a nosebleed that does not stop, your provider may insert soft packing material into the bleeding nostril.

You may have had a nasal septal hematoma. This is a collection of blood within the septum of the nose. The septum is the part of the nose between the 2 nostrils. An injury disrupts the blood vessels so that fluid and blood may collect under the lining. Your provider may have made a small cut or used a needle to drain the blood.

If you have an open fracture, in which there is a cut in the skin as well as broken nasal bones, you may need stitches and antibiotics.

If you need a reduction or surgery, you will need to wait until most or all of the swelling has gone down before a complete assessment can be made. In most cases, this is 3 to 14 days after your injury. You may be referred to a specialist such as a plastic surgeon or an ear, nose, and throat doctor, if the injury is more severe.

Symptom Relief

For simple breaks, in which the nasal bone is not crooked, in order to keep pain and swelling down, your provider may advise you to:

• Take relative rest. Try to keep away from any activity where you could bump your nose.
• Ice your nose for 20 minutes, every 1 to 2 hours while awake. Do not apply ice directly to the skin.
• Take pain medicine if necessary.
• Keep your head elevated to help reduce swelling and improve breathing.

For pain, you can take ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), aspirin, or acetaminophen (Tylenol). You can buy these pain medicines without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or bleeding.
• Do not take more than the amount recommended on the bottle.
• Do not give aspirin to children.

Tell your provider about any other medicines you are taking as medicine interactions may occur.

Activity

You can keep doing most daily activities, but use extra care. It may be difficult to exercise strenuously because breathing through your nose may be impaired by swelling. Try not to lift anything heavy unless your provider says it is OK. If you have a cast or splint, wear this until your provider says it is OK to take it off.

You may have to avoid sports for a while. When your provider tells you it is safe to play again, make sure to wear face and nose guards.

Self-care at Home

Do not remove any packing or splints unless your provider tells you to.

Take hot showers to breathe in the steam. This will help ease stuffiness and break up mucus or dried blood that builds up after surgery.

You may also need to clean the inside of your nose to get rid of dried blood or drainage. Use a cotton swab dipped in warm soapy water and carefully wipe the inside of each nostril.

If you take any medicines nasally, talk to your provider before using them.

Follow-up

Follow up with your provider 1 to 2 weeks after your injury. Based on your injury, your provider may want to see you more than one time.

Prognosis (Outcome)

Isolated nasal fractures usually heal without significant deformity, but surgery may be needed to correct more serious cases. If there has also been injury to the head, face and eyes, additional care will be needed to prevent bleeding, infection, and other serious outcomes.

When to Call the Doctor

Contact your provider if you have:

• Any open wound or bleeding
• Fever
• Foul smelling or discolored (yellow, green, or red) drainage from the nose
• Nausea and vomiting
• Sudden numbness or tingling
• Sudden increase in pain or swelling
• Injury does not seem to be healing as expected
• Difficulty breathing that does not go away
• Any changes in vision or double vision
• Worsening headache

References

Chegar BE, Tatum SA. Nasal fracture. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 30.

Mayersak RJ. Facial trauma In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 34.

Reddy LV, Harding SC. Nasal fractures. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery. 3rd ed. St Louis, MO: Elsevier; 2018:chap 8.

Review Date: 4/3/2024  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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