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?

Doctor Answers 7

Facial bone x-rays may not be helpful for diagnosing and managing a nasal fracture.

The hallmark of a nasal fracture is nose bleeding, swelling, and bruising after sustaining trauma. You may also experience nasal obstruction and a change in your nasal appearance. Whenever there is a question about the possibility of a nasal fracture, you should see a reputable ENT or nasal specialist. Pain associated with your nasal septum could represent a septal hematoma which should be drained, if present, to avoid loss of cartilaginous support. Thank you. Dr Joseph

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 418 reviews

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

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 75 reviews

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.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

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.

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

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..

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

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.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

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.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 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.