Could my son's nose be broken without significant swelling or bleeding? (photo)

Dear Mom,I am sorry to hear of your son's incident. From the images you provided, I do notice the deviation that you and your husband could see. However, I do not think it will be a problem. Since he is young, there is still cartilage and bone growth occurring. If your concerns persist, I suggest taking him to the doctor for a consultation and in person perspective on the issue.Best of luck!Dr. Ali Sajjadian

Its always difficult to know if a nose is fractured after a fall, especially in kids! A child's nose has more cartilage and can move a bit more. Often with a real fracture you will get bleeding, swelling and some nasty black eyes. Another possibility is that the septum is moved a bit. Finally,  it may just be swelling. the best way to figure this out is to see a physician in person and have them examine it.  

I'm sorry to hear of your son's fall; it certainly doesn't sound dramatic, and the photos show only slight swelling on one side of the nose, patent airways without obvious septal deviation (at least anteriorly as far as one can see), and a tiny bruise on the nasal tip near the front of the left nostril.So, yes, fracture is possible, but given the minimal degree of swelling, the lack of nosebleed, and no obvious major deformity, I would suggest that more damage cold be done by trying to "straighten" a nose that may in fact be straight and simply swollen on one side (the side of the bruise). BUt that's only part of the story.Noses have three purposes on our bodies, and one of them is appearance. If there is an externally-visible deformity it can be manually set and splinted up to about two weeks after injury--after that things have begun to heal. In the setting of significant swelling (not here), it's hard to determine what is "straight" and what is not because of the swelling, which could be asymmetrical. Trying to straighten asymmetrically swollen bones and cartilages may leave them more crooked than when you started. So, even though you might theoretically have up to two weeks to align things, swelling occurs pretty much immediately, and makes this plan of action often not such a good idea.The second thing noses do is smell, and that occurs way up inside the nose at the base of the brain. This is rarely damaged, even with severe trauma, so that can likely be dismissed here. (But easily checked with lemon, ammonia, etc.)The third critical thing noses do is to allow breathing. Thus, function can be damaged, even if the nose looks pretty good. Again, swelling can certainly muddy up the diagnostic here, so often swelling must be allowed to subside before considering that either form OR function has been altered for the worse. Septal deviation or hematoma can lead to perforation or long-term deformity and loss of function, so that is the benefit of surgical consultation and internal nasal examination at this point when treatment can be performed.It seems as if most parents are concerned about appearance, but that does not take into account the very real possibility of persistent and troublesome airway blockage from uncorrected septal damage. See an ABPS-certified plastic surgeon or ABO-certified ENT surgeon as soon as possible. A quick internal nasal exam can put your mind at ease. Best wishes! Dr. Tholen