What to do about a broken nose?

If you’ve just gotten smacked in the face (it happens to the best of us!), it is important to know what to do afterwards.  The first and most important thing is to make sure the brain is OK, so it is best to receive a proper emergency evaluation.  Keep in mind that the elderly are the most at risk for serious injury.   Thankfully, many times the injury is diagnosed as an isolated fracture of the nasal bones.  So now what?

The nose is most projecting part of the face, which means it is the first to make contact with an incoming object (child’s head, baseball, defender’s elbow, the sidewalk).  Additionally, the nasal bones are very thin and weak, which explains why the nose is one of the most commonly broken bones in the body.

The injury

The nasal skin swells immediately after injury.  The nose hurts to touch.  There can be some bleeding, or possibly a laceration of the overlying skin.  It is a good idea to start applying ice right away to reduce the swelling and inflammation – something like 10-15 minutes of ice application every hour or so or even more frequently.  This can help the pain if the nose hurts, and can also help you figure out early if the injury has resulted in a crooked nose.  Although tempting, it may be wise to avoid ibuprofen or other NSAIDs initially since these can raise the risk of bleeding. 

The treatment

There are two reasons to perform an intervention on a broken nose – if breathing is compromised, or if the nose is crooked.  It is important to make this decision early since intervention is best done within two weeks of the injury.

Early breathing problems after injury can be the result of swelling inside the nose, or a new fracture of the nasal septum (which divides the nose into left and right sides), or even a collection of blood in the septum (hematoma).  This should be part of the initial specialist’s evaluation.  If breathing is affected, it may require surgical intervention to correct. 

If the nose is crooked, an early intervention can help prevent the deformity from healing in place.  If it is difficult to tell, aggressively icing the injury can help reveal the extent of the deformity.  The procedure itself is simply a “reduction” – the existing fracture lines are used to put the bones back in their original place or as close as possible. If the nose is still crooked, either after an initial reduction or if no intervention was done after the injury, it is best to wait up to a year before attempting correction.  This is to allow the bones to heal completely. 

Since you know from experience that breaking the nose can be quite painful, we typically perform this with some degree of anesthesia.  Generally a cast is applied to the outside of the nose, or in some cases packing may be required to stabilize the bone after treatment.  You should discuss the postoperative care with your surgeon. 

Remember, a broken nose is a treatable condition and should be treated within the first two weeks of injury.  Even if you decide to leave the nose alone, it is best to consult with a specialist early on to help you make the best decision.  

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