I got in a little scuffle and my nose is hurt and swollen. How Do I Know if my Nose is Broken?
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How to treat a broken nose
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Possible broben nose
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
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.
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Enough nonsense. Plain x-rays are pointless.
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,
Wait for the swelling to go down
If the nose did not bleed, it is probably not broken. Wait for the swelling to go down (a few weeks) and if you think the nose looks the same, do nothing. You save money and time.
Is My Nose Broken?
Assessment Of A Broken 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.
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.
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
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.
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.