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
What are the signs and symptoms of a broken nose?
Doctor Answers 104
How to treat a broken nose
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,
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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.
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?
A broken arm has to be set and placed in a cast regardless of whether or not the bones are in their proper position. This is not the case with a broken nose. As long as your nose has not shifted externally and or if there is not internal damage which can result in nasal obstruction from a deviated septum, immediate surgery is not required. Sometimes swelling from trauma can obscure external changes and internal blockage. Its ok to wait a week to make a final determination as the bones don't begin to set until the two week mark. Often, as swelling comes down, it will be apparent that there is minimal to no external change and internal breathing goes back to normal. Whether a nasal x-ray showed a fracture or not, the management will be based on external appearance and breathing function.
Patients who have an obvious deformity and or blockage to breathing will benefit from nasal fracture reduction and correction of a deviated septum if its affecting breathing 7 to 14 days from the injury.
Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York
Board Certified Facial Plastic Surgeon (ABFPRS)
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Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for:
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Thanks for your question. A broken nose or nasal fracture can be difficult to diagnose because not all fractures will result in an obvious cosmetic deformity of the nose. In addition not all nasal injuries will cause a problem with breathing either. In fact trouble breathing or a cosmetic deformity are really the only reasons why you need to repair a nasal fracture. In the absence of an obvious deformity, it may be difficult to tell what is going on with the nasal bones due to swelling, pain etc. Imaging can be valuable especially if surgery is being contemplated for one of the previously mentioned reasons. If imaging is going to be performed, I strongly suggest requested a CT scan as opposed to plain film X-rays. A CT scan will give the necessary three dimensional orientation of the nasal bones/injury and is very helpful for surgical planning, much more so than a plain film X-ray, and is not much more radiation either. Typically the ER will try to obtain a plain film X-ray with the thought that it is cheaper and less radiation (both are true); however it doesn't given much helpful information to the surgeon. In short if you are concerned about a nasal injury, it's probably best to seek the opinion of a well trained nasal surgeon prior to doing anything. You may or may not need imaging, but at least you'll get an expert opinion. If you are in an ER setting, request a CT scan and either a consult or follow up appointment with a well credentialed rhinoplasty surgeon. Hope this helps
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.
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.