Nasal Fractures

How do you get a broken nose and what can be done about it?It isn’t surprising that the nose is the most commonly broken bone on the head, considering its prominence and protrusion. Though patients have rhinoplasty for many other reasons, it is not uncommon for someone who has had a nasal fracture to require cosmetic, as well as medical, repair. A nasal fracture, even if it heals without surgery and breathing remains normal, can significantly alter your appearance and result in a “crooked nose“. In many cases, someone who has suffered a broken nose years ago will decide to have a rhinoplasty procedure to restore, or improve upon, their pre- injury appearance.Causes of Nasal FracturesEven a slight bang on the nose can be quite painful; a nasal fracture is that much worse. You may suffer a nasal fracture for any number of reasons. The comic strip variety, of course, usually involves a punch in the face, and a certain number of broken noses do occur as a result of assault — in cases of criminal stranger attack, domestic abuse, or in the boxing ring. Other causes of nasal fracture not involving intentional violence can occur during contact sports, slip and fall accidents, vehicular crashes, or that old standby — walking into a door. It is also possible for dental and jaw injuries to result in a nasal fracture.Symptoms of Nasal FracturesThere are a variety of symptoms that may occur as a result of a broken nose, including:

• Extreme pain
• Nose bleed
• Difficulty breathing through the nose
• Swelling both inside and outside the nose
• Dark bruises around the eyes (“black eyes”)

Because nasal fractures commonly affect both bone and cartilage, patients may develop an accumulation of blood, known as a septal hematoma, on the nasal septum (the wall between the nostrils). A septal hematoma is a medical emergency.Diagnosis of Nasal FracturesIn diagnosing nasal fractures, doctors do a thorough physical examination of your face, including the eyes, jaw and teeth, looking for bruising, cuts and swelling. While in most cases an X-ray or CT scan will be taken, such tests will not always reveal fractures of the nose. The fundamental bases of diagnosis are abnormal appearance of your nose in terms of shape or symmetry, and whether you are having difficulty breathing through it.Immediate Treatment Options for Nasal FracturesIf the doctor diagnoses a nasal fracture but your nose remains correctly positioned on your face, you may only need to rest and protect your nose from further injury. If, on the other hand, your nose needs to be repositioned, depending on the severity of the injury, the doctor may be able to perform an in-office procedure under local anesthesia.In the latter case, while you are locally anesthetized, your broken bones are repositioned correctly and held in place by a cast for about a week. If the surgery cannot, for some reason, be performed immediately after the injury occurs, it is usually performed about two weeks later under general anesthesia in a hospital operating room.In many cases, more than two weeks pass after the injury, either because the nasal fracture was not properly diagnosed or because the patient didn’t realize that more care was required at the time. In these circumstances, you will have to wait two to three months before having a surgical repair. By this time, the swelling will have gone done and the surgeon will be able to get a clearer picture of how your nose looked before the injury.When more time has elapsed since the injury, the surgery to be considered is reconstructive rhinoplasty, best performed by a doctor who specializes only in nose surgery. The upside to waiting months, or even years, to have the repair is that the rhinoplasty surgeon will not only be able to restore your nose to its original appearance, but will be able to improve upon its contours and remove its imperfections.