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I got in a little scuffle and my nose is hurt and swollen. How Do I Know if my Nose is Broken?

Ok, i got in a little scuffle and my nose is hurt and swollen - how do I know if it's broken?

Doctor Answers (59)

How to treat a broken nose

+5
Here is my take on broken noses:  A nose can be technically broken but not have outward or inward deformity and not cause any cosmetic or functional change:   You look the same (after the swelling goes down in a week) and you have no change in nasal breathing.  Thus, regardless of an x-ray finding, nothing needs to be done.  If there is an obvious deformity or difficulty breathing after a week, then further treatment is indicated. 
 


New York Facial Plastic Surgeon
4.5 out of 5 stars 42 reviews

Possible broben nose

+4

It can actually be very difficult to tell if a nose is broken.  Obviously if the nose is way off to one side it probably was broken, if it is severely flattened and depressed it is probably broken, and if the bones move it is broken. However if the nose is generally swollen and basically in the middle it is hard to tell. Even x-rays can be deceptive at this time. I always tell patients like this to wait 10 days and then reevaluate . By then enough swelling should be gone to tell what is really happening, and the bones should still be mobile if repositioning is needed. I rarely get x-rays except to document the injury for legal matters. My hands and examination give me far more information that an x-ray

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Broken nose?

+3

Besides obviously having a crooked nose after nasal trauma, patients may have broken their nose and have more subtle findings. One good indication that you may have broken your nose is if you had a bloody nose immediately after a particular nasal trauma event. The reason why, is the nasal bones blood supply is provided by a structure called the periosteum. This structure surrounds the nasal bone and is as thin and fragile as tissue paper. So when the bone fractures,the periosteum overlying the fracture sheers and results in bleeding. I always ask this question to patients I evaluate after nasal trauma.

Edward S. Kwak, MD
Manhattan Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

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Enough nonsense. Plain x-rays are pointless.

+3

Please ignore the advice to get an x-ray of your nasal bones. It's nonsense!

The only role for x-rays might be if there were concern about fractures other than the nasal bones (e.g., the orbits, mandible, maxilla, etc.) but then in those cases a maxillofacial CT scan is better.

So assuming that the only concern is a nasal fracture, here's why x-rays are a waste of time and money:

1) if the nose is obviously crooked when the swelling subsides (and wasn't crooked before), then you know it's broken and you don't need the x-ray to tell you that since it won't change clinical decision making. [A closed reduction in the O.R. between one to two weeks after the injury can restore the pre-injury alignment.]

2) if the nose is straight when the swelling subsides after a few days, then who cares if it's broken? It will heal in place and needs no further intervention beyond avoiding further trauma.

The point is, the results of the x-ray--regardless of what it indicates about the nasal bones--won't change the decision making. Granted, if you go to the E.R., they'll get x-rays, but that's mainly to keep the lawyers off their backs. ;-)

Frankly, your doctor's fingers (and hopefully his/her brain) will be more accurate than an x-ray in this circumstance.

One caveat: It's still important to rule out a septal hematoma when a nasal fracture is suspected. The E.R. doc or your otolaryngologist/facial plastic surgeon/general plastic surgeon should be able to look up your nose and determine this.

All the best,

--DCP

David C. Pearson, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Is My Nose Broken?

+2
It may be hard to tell you nose is broken immediately after the injury.  If your nose starts to bleed, or there is any discoloration under the eyes, it is more likely that the nasal bones may have been injured.  If there is a change in the breathing, or significant congestion, the nose must be checked to make sure that the septum has not been injured as well.  Your doctor needs to check for a  septal hematoma, or a collection of blood inside the nose, as this is something that needs to be treated immediately.  The main issue in a nasal bone fracture is how the nose looks.  If the bones have been fractured, but they have not moved out of position, then no treatment may be necessary .  A nasal bone fracture is a clinical diagnosis, meaning that an X-ray may not be the best way to make a decision.  An x-ray can show a fracture, but  the nose may look straight.  Conversely, there can be a significant change, and the x ray may be negative.  In addition, if there is injury to the cartilage of the nose, something may need to be done as well.  The best bet is be be examined immediately, or as soon as possible after the injury to make sure that no immediate intervention is necessary. If it your doctor feels that the changes are only due to swelling, you should be rechecked at a week to make sure how the nose looks and make sure that the breathing is ok.

Jennifer Levine, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Assessment Of A Broken Nose

+2
Trauma to the nose can injure the internal and/or the external parts of the nose.

Regarding the internal structures, the septum can be injured resulting in a deviated septum.  This means it is no longer located in the middle of the nasal cavity, and can cause difficulty breathing as well as nose bleeds and in more rare instances recurrent sinus infections.  However, in the acute (early) timing of the injury it is important to make sure there is not a septal hematoma, which is a blood clot collection between the cartilage of the septum and the mucosal lining of the septum.  You don't necessarily have to have a nosebleed to have a septal hematoma.  This is a situation that needs to be ruled out early within the first day or two of the trauma by physician familiar with this diagnosis.  Septal hematomas are rare, but when missed and not addressed, can cause the cartilage of the septum to dissolve, and result in a collapsed bridge of the nose known as a "saddle deformity".  It is in the patients' best interest to have this examined as early as possible.  If a deviated septum has occurred, that can typically be corrected in the OR as an out patient with a minimally invasive Septoplasty.  A saddle nose deformity is more complicated but also can be addressed as an out patient procedure in the OR.

Assessment of the external structures usually involves the nasal bones.  Xrays are typically of little help for a nasal fracture, even though the are often ordered by ER physicians.  Xrays can show a fracture, but don't tell a physician of the fracture is new or old.  It is fairly common that patients have had a fracture of one of their nasal bones in the past (previous sports, learning how to walk as a toddler, etc...) but the fracture never became displaced i.e. the bones stayed lined up and didn't shift and so healed in correct alignment.  As you can see, Xrays can be very misleading for the clinician.  Therefore, If a septal hematoma has already been ruled out, then the best time to assess for a fracture of the nasal bones is at approximately 7 days when the swelling has subsided.  It is then that if there is any new changes to the appearance of the nose surgical correction be recommended.  The nasal bones have not yet completely healed at 7 days, and therefore sometimes can be manipulated back into proper position under a brief anesthetic in the OR, and a splint (bandage) worn for 7 days, hopefully avoiding any further surgery in the future.

Burke Robinson, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Nasal fracture

+2

Often I ask patient's who have minor injuries if they suffered a nose bleed or notice a change to their breathing immediately after the injury?  If both answers are no then odds are you are seeing merely tissue swelling and nothing else.

Shepherd G. Pryor, MD
Scottsdale Facial Plastic Surgeon
4.5 out of 5 stars 20 reviews

Broken nose?

+2

Here are a few tips to figuring out whether nor not you broke your nose.  One or more of them should get you to see a facial plastic surgeon:  

With the swelling gone, about 7 days, it looks different.  

It is crooked now and was not before your less than friendly encounter.  

It still hurts 7 days after the injury

You heard a crack and it bled

You can feel an irregularity in the bones that was not there before

You have bump in your nose that you did not have before

You have trouble breathing through your nose; indicates a possible break in the nasal septum

GOOD LUCK

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Nasal Fracture

+2

Diagnosis of nasal fracture is typically best performed by an in person evaluation with an experienced physician in nasal anatomy.  The physician can palpate your nose, examine the inside of your nose with anterior rhinoscopy, and order additional studies if necessary.  While a plain x-ray is sometimes required by an insurance company for diagnosis, there is little to no diagnostic value in ordering this.

An experienced nasal surgeon can:

  • Determine the location of nasal fracture
  • Type of fracture- Septal cartilage, nasal bones, avulsed upper lateral cartilage, perpendicular plate of the ethmoid, etc
  • Rule out dangerous complications of nasal trauma such as a septal hematoma, CSF leak, etc
  • Discuss the best course of treatment for your nasal fracture which may include observation, early closed reduction of the nasal fracture, osteotomies of the nose to reposition the nose.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 76 reviews

Best time to examine/reduse nasal bones is 7 days post injury

+2

Nasal fractures are very common. Many young children fracture their noses and don’t even know it. As an adult if you sustain a nasal fracture you can expect significant swelling and bruising within a few hours of the injury.

Whether or not your nose is fractured may not be that important. If it still looks good, your breathing returns to normal and you have no other symptoms, fractured or not it doesn't require any treatment.

I recommend seeing an ENT surgeon 1 week after the injury when the swelling has settled to have a complete nasal exam. At this time, a closed reduction can be done if the nose needs to be straightened.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.