Can Your Nose Cartilage Be Broken Even if X-rays Are Negative?

I fell onto my face, and had severe bleeding from the R side of my nose for about 5'. It swelled but there was not much bruising. I had a large hematoma under my top lip. The urgent care doc said that my septum was a bit off to the R. It's been 2 weeks and my nose is still acutely painful, especially if I put my finger inside the R side of the nose and press inward, even a tiny bit. Is it possible for the cartilage to be broken even if the bones aren't?

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6 Doctor Answers | Asked by mgsondance

Doctor Answers (6)
Community Comments (2)

Broken Cartilage Not Seen In X-Ray

Yes, it is possible that the cartilage is broken, even with a negative X-Ray. X-Rays are used to show disturbances within the bone, not soft tissue like cartilage. For an accurate examination of the cartilage you will need a cat scan and an examination by a doctor. Jaime Perez, MD Rhinoplasty Specialist Plastic Surgery Center of Tampa

You don't need X-Rays to diagnose a broken nose, plus they may be negative

Basically, if you get hit in the nose and it's crooked but wasn't before it's broken. I have seen a number of noses that are obviously broken (quite crooked) but had negative X-Rays. There really is no real reason to get an X-Ray other than to prove to an insurance company it's broken. Alternatively, I have seen broken noses by X-ray that are straight and therefore don't need any treatment other than being careful for a month or so.

Nasal Cartilage

It sounds like you sustained a fair amount of blunt nasal trauma just two weeks ago. However, routine facial radiographs will most likely miss non-displaced, uncalcified nasal cartilaginous fractures. Therefore, please follow-up with an experienced Facial & Reconstructive Cosmetic Surgeon for further work-up of your current problem.

Cartilage Problems Without a Nasal Fracture Are Certainly Possible

An X-ray looks at bone and most of the time (unless the cartilage is calcified) doesn't show cartilage very well. You certainly could have broken the cartilage of the septum without breaking the nasal bones. So, even with a "normal" x-ray you could have issues with the cartilage that need to be dealt with. I recommend you see an ENT doc, Facial Plastic Surgeon, or experienced rhinoplasty surgeon to take a look. Best of luck..

Your nose can be broken even if the x-rays are normal

The nasal bone is often a fairly small portion of the nasal bridge and it indeed possible to have a fracture that cannot be noticed on an x-ray. Also the septum is largely cartilage and can be displaced by a fracture or a hematoma (bleeding). The ER can handle the acute care, but followup with a plastic surgeon right away.

Can Your Nose Cartilage Be Broken Even if X-rays Are Negative?

It's unwise to manipulate your nose until you have been examined by an experienced Rhinoplasty Surgeon to rule out nasal fractures and septal injury (including septal hematoma). Only ~ 1/3 of the nose is comprised of bone and would show fractures on an XRAY. The remaing ~ 2/3, of the nose is cartilage that is clear on XRAYS and would not show cracks or breaks. Hope this helps.

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Comments (2)

mgsondance 8 Aug 2012

dr. pearlman- so if my nose is straight (no one but me would notice it, now that the swelling is down), i really don't need to go see anyone about it? the other responses all recommended seeing a plastic surgeon or ENT. my only concern is that my nose is already stuffed up a good deal of the time because i have a ton of allergies, and my docs are really pushing me to use cpap again. the only mask that fits me only goes over the nose so i want to make sure my breathing passages are clear. the Urgent Care doc said they were. if you do think i should go, should i go see a plastic surgeon, or an ent?

thanks SO MUCH for your time!