Definition

A nasal fracture refers to a broken nasal bone. The primary causes of nasal fractures include sports injuries, accidents, fights, falls, and other mechanisms that could cause facial trauma. Symptoms of a broken nasal bone include pain, swelling, and bruising around the nose and eyes. The nose may appear crooked, and breathing difficulties may occur.

Causes

Here are some possible causes of nasal fractures: 

• Sports injuries (e.g., soccer, hockey)
• Accidental trauma to the nose
• Traffic or motor vehicle accidents
• Falls

Risk factor

Participating in high-risk activities is one of the risk factors for nasal fractures. These activities include:

• Frequently participating in high-contact sports such as soccer or hockey, especially without protective gear (helmets, etc.)
• Engaging in physical fights
• Riding a bike without proper safety equipment
• Weightlifting without a spotter

Symptoms

Here are symptoms that could occur in nasal fractures:

• Pain and tenderness of the nose that could occur if the nose is touched or pressed
• Swelling around the nose
• Nosebleeds
• Bruising around the eyes
• Asymmetrical or slanted nose
• Difficulty breathing through the nose
• Blocked nostrils

Diagnosis

When you visit a doctor for a nasal fracture, the doctor will ensure your condition is stable. Once the patient is stable and able to communicate, the doctor will ask questions to help establish the diagnosis. These questions may include inquiries about the mechanism of injury, any protective equipment used, and any prior treatments received.

The doctor will inspect your face for any changes in the structure of your nose, swelling, eye bruising, nosebleeds, and alterations in eye movement. Severe nasal bone fractures can trap the eye muscles, restricting eye movement in certain directions.

The doctor will press on the outer part of your nose and its surrounding area. They will also assess your respiratory tract for obstructions and other symptoms that might indicate a fracture. The doctor will also check your nasal cavity for any blood or cerebrospinal fluid discharge (the fluid surrounding the brain and spinal cord).

If the initial assessment indicates, the doctor may perform radiological imaging tests, such as a skull X-ray or a CT (Computed Tomography) scan, to detect any other possible bone fractures. 

Management

First Aid

If you feel you experience a broken nose, follow these steps:

1. Stay calm.
2. Breathe through your mouth and keep your face downward to prevent blood from flowing into your throat and esophagus. Please remain seated to avoid dizziness.
3. Press your nostrils and nasal cartilage to stop the bleeding.
4. Apply ice to your nose to reduce swelling. Do this at least 4 times daily for 10-15 minutes over the first 24-48 hours after the injury. Cover the ice with a cloth to prevent frostbite, and avoid putting too much pressure on your nose to minimize pain.
5. Take acetaminophen or ibuprofen to reduce pain.
6. Do not attempt to straighten or move your nose.
7. Sleep in an upright position for a while.
8. For the next 2 weeks, limit physical activities such as exercise.

Visit the nearest healthcare facility if your nose significantly changes shape or you experience persistent bleeding or clear fluid discharge. If the injury is severe, go to the emergency room immediately to get treated. For mild to moderate injuries, you can wait and visit the clinic on a working day, but ensure you get checked within 3-5 days after the incident.

Medical Treatments

For minor injuries that do not alter the shape of your nose, further medical assistance may not be necessary. The doctor will advise treating the injury at home by applying cold compresses and taking over-the-counter pain relievers.

For severe injuries that change the shape of your nose, a doctor will need to reposition your nose:

• Manual realignment. The nose will be realigned manually. This procedure should be done within 14 days of the injury. During the procedure, the doctor will:
• Administer medication through the nose or via injection to reduce pain.
• Use a speculum to open the nasal cavity.
• Use specific instruments to realign the nasal cartilage and bones into their normal position.
• Apply a splint to maintain the nose's position for 1 week.
• Prescribe antibiotics and pain relievers.
• Surgery. For more serious conditions, such as multiple facial fractures, the doctor could refer you to a plastic surgeon since they are more qualified to perform the surgery. This cannot be treated manually, and the procedure is typically performed within 14 days of the injury.

Complications

Complications of nasal fractures include:

• Septal deviation. Nasal fractures can alter the position of the nasal septum, a cartilage and bone structure dividing the right and left nostrils. Head and facial injuries or falls can cause the septum to shift, obstructing one of the nasal passages. Initial treatments may include medications like decongestants and antihistamines, but surgery is often necessary to correct the septum's position.
• Formation of blood clots in nasal septum. Sometimes, blood can collect and clot in the nose, forming a septal hematoma. This condition requires prompt professional intervention to remove the clots, preventing damage to the nasal cartilage.
• Cartilage fracture. Serious injuries, such as those caused in car accidents, can also fracture the nasal cartilage. In these cases, doctors will thoroughly examine the bones and cartilage before proceeding with any treatments.
• Cribriform plate fracture. Fractures of the cribriform plate, the bone lining the cranial and nasal cavities, can cause cerebrospinal fluid (CSF) leakage. This fluid is clear and watery and can drip from the nose.
• Septal abscess. Bleeding into the nasal cartilage can accumulate pus, forming a septal abscess. If untreated, this can alter the nose's shape.\

Prevention

You can prevent nasal fractures by adhering to the following guidelines:

• Always use a seat belt when driving, and avoid sitting your child in the front seat. Ensure your child uses appropriate car seats for their age to guarantee their safety.
• Wear protective equipment, such as helmets and face shields, when engaging in sports that involve physical contact.

When to see a doctor?

Seek immediate medical attention if you or someone nearby experiences nasal trauma accompanied by:

• Head and neck injuries indicated by severe headache, neck pain, vomiting, or loss of consciousness
• Difficulty breathing
• Persistent bleeding
• Noticeable changes in the shape of the face not related to swelling, such as the nose appearing crooked or twisted
• Clear, watery discharge from the nose

Read more articles about ear, nose, and throat disease here, yes!