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

Question

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?

Eric M. Joseph, MD · Answer

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

Jaime Perez, MD · Answer

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

Steven J. Pearlman, MD, FACS · Answer

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.

Michael R. Menachof, MD · Answer

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..

Peter E. Johnson, MD · Answer

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?

Answers (7)