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

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

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

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.

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..

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.

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.

 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.