Broken Nose: Symptoms, Treatment & Recovery Guide

What Is a Broken Nose?

A broken nose (nasal fracture) occurs when the nasal bones or cartilage crack or break, typically from direct trauma to the face. The nose consists of two small nasal bones at the bridge and cartilage structures including the nasal septum. Fractures can range from minor cracks to severe displacement affecting both bone and cartilage.

The nose is the most prominent feature of the face and, consequently, the most vulnerable to injury. Understanding the anatomy helps explain why nasal fractures vary so significantly in severity and treatment requirements. The upper third of the nose is composed of the nasal bones, which are relatively thin and brittle. These bones articulate with the frontal bone above and the maxilla on either side. The lower two-thirds consists primarily of cartilage, including the septal cartilage that divides the nasal cavity and the lateral cartilages that provide structural support.

When force is applied to the nose, the pattern of fracture depends on the direction and magnitude of impact. A direct frontal blow tends to cause bilateral fractures with depression of the nasal bridge. Lateral impacts often result in displacement of the nose to one side, potentially affecting the septum as well. The cartilaginous portions, while more flexible, can still be damaged, and injuries to the septum are particularly significant because they can cause breathing difficulties and require specific treatment approaches.

Nasal fractures represent approximately 40% of all facial bone fractures, making them the most common type of facial injury. They occur most frequently in males between the ages of 15 and 30, often related to sports participation, physical altercations, or accidents. However, nasal fractures can occur at any age and affect both sexes, with causes ranging from childhood falls to motor vehicle accidents in older adults.

Common Causes of Broken Nose

Understanding the mechanisms of injury helps both in prevention and in anticipating the type of damage that may have occurred. The most common causes include:

• Sports injuries: Contact sports like basketball, football, soccer, hockey, boxing, and martial arts account for a significant percentage of nasal fractures, particularly among young athletes
• Falls: Falling from bicycles, during physical activities, or from standing height (especially in children and elderly) frequently results in nasal trauma
• Physical altercations: Punches and strikes to the face commonly target or inadvertently hit the nose due to its prominent position
• Motor vehicle accidents: Even with airbag deployment, facial impact during collisions can cause nasal fractures
• Workplace accidents: Industrial injuries, particularly those involving sudden impact or falling objects

What Are the Symptoms of a Broken Nose?

The main symptoms of a broken nose include pain and tenderness, swelling of the nose and surrounding areas, visible deformity or crookedness, nosebleeds, difficulty breathing through the nose, and bruising around the nose and eyes. A crunching sound when touching the nose (crepitus) is a strong indicator of fracture.

Recognizing the symptoms of a nasal fracture is essential for seeking appropriate care. While some signs are immediately obvious, others may develop over the hours and days following injury. The severity of symptoms does not always correlate directly with the severity of the fracture, as significant swelling can mask underlying structural damage.

Pain is typically the first and most prominent symptom, often described as intense and throbbing. The pain is usually localized to the nose but may radiate to surrounding facial areas. Touching or moving the nose typically intensifies the discomfort. The degree of pain varies considerably among individuals and may be influenced by factors such as concurrent injuries and individual pain tolerance.

Swelling develops rapidly after injury and may continue to increase for 24 to 48 hours. The swelling can be quite dramatic, sometimes making the nose appear significantly larger than normal and obscuring any underlying deformity. This is why medical professionals often recommend a follow-up examination after swelling has subsided to accurately assess the fracture and determine if intervention is needed.

Visible deformity occurs when the nasal bones are displaced from their normal position. The nose may appear crooked, deviated to one side, or pushed in (depressed). However, as mentioned, swelling may temporarily mask this deformity, and it may become more apparent as swelling resolves. In some cases, the deformity is immediately obvious and unmistakable.

Signs of Mild to Moderate Fracture

In many cases, nasal fractures present with a constellation of symptoms that, while uncomfortable, do not represent an emergency:

• Tenderness when touching the nose
• Moderate swelling localized to the nose
• Minor nosebleed that stops within 15-20 minutes
• Difficulty breathing through one or both nostrils
• Feeling of nasal stuffiness or congestion
• Bruising around the nose that may extend to the cheeks

Symptoms Requiring Immediate Medical Attention

Certain symptoms indicate potentially serious complications that require urgent evaluation:

When Should You See a Doctor for a Broken Nose?

Seek medical care immediately if you have difficulty breathing, uncontrolled bleeding, clear fluid draining from the nose, severe deformity, or associated head injury symptoms. For suspected fractures without these emergency signs, see a healthcare provider within 1-2 days for proper evaluation before swelling obscures the injury.

The decision about when to seek medical care for a suspected broken nose depends on the severity of symptoms and the presence of any warning signs. While many nasal fractures do not constitute true emergencies, appropriate medical evaluation is important to identify complications and determine the need for treatment.

Immediate emergency care is warranted when there are signs of serious injury beyond the nose itself. Clear, watery fluid draining from the nose after head trauma may indicate a cerebrospinal fluid leak, which occurs when there is a fracture extending to the base of the skull. This is a serious condition requiring immediate evaluation and treatment. Similarly, any loss of consciousness, persistent confusion, or severe headache following facial trauma suggests the possibility of a concurrent head injury.

Breathing difficulties that are severe or accompanied by signs of respiratory distress require urgent attention. While mild nasal congestion is expected with any nasal injury, complete inability to breathe through the nose or the sensation of struggling to breathe warrants immediate evaluation. This may indicate a septal hematoma, severe deviated septum, or other conditions requiring prompt treatment.

For injuries that do not meet emergency criteria but appear to involve a fracture, scheduling an evaluation within 24 to 48 hours is advisable. This timing allows for initial swelling to be managed while ensuring assessment occurs before bones begin to set in abnormal positions. If surgery is indicated, it is typically most effective when performed within 10 to 14 days of injury.

How Do You Provide First Aid for a Broken Nose?

For first aid, sit upright and lean slightly forward to prevent blood from going down the throat. Apply a cold compress wrapped in cloth for 15-20 minutes to reduce swelling. Pinch the soft part of the nose (not the bridge) for 10-15 minutes to control bleeding. Take acetaminophen for pain, avoiding aspirin and ibuprofen initially.

Proper first aid management immediately following a nasal injury can significantly impact comfort and may influence healing outcomes. The goals of initial care are to control bleeding, minimize swelling, manage pain, and prevent further injury while arrangements are made for medical evaluation if needed.

Positioning is the first consideration. The injured person should sit upright rather than lie down, and lean slightly forward. This position serves two purposes: it uses gravity to help reduce blood flow to the injured area, and it prevents blood from draining down the throat, which can cause nausea, vomiting, or choking. The common advice to tilt the head back is actually counterproductive and should be avoided.

Cold application is one of the most effective immediate interventions for reducing swelling and providing pain relief. An ice pack or bag of frozen vegetables wrapped in a thin cloth should be applied to the nose and surrounding areas. Direct contact between ice and skin should be avoided to prevent cold injury. Apply the cold compress for 15 to 20 minutes at a time, with breaks of at least 10 minutes between applications. This can be repeated multiple times in the first 48 hours.

Bleeding control is often necessary, as nosebleeds frequently accompany nasal fractures. To control bleeding, pinch the soft, fleshy part of the nose (not the hard bridge) firmly between the thumb and index finger. Maintain steady pressure for at least 10 to 15 minutes without checking to see if bleeding has stopped, as interrupting pressure too early allows clots to dislodge. Breathing should occur through the mouth during this time. Avoid stuffing tissues or gauze into the nostrils, as this can cause additional trauma and make bleeding worse when removed.

Step-by-Step First Aid Instructions

1. Ensure safety: Make sure the person is in a safe location away from any ongoing danger
2. Position correctly: Have them sit upright and lean slightly forward
3. Control bleeding: Pinch the soft part of the nose for 10-15 minutes
4. Apply cold: Use an ice pack wrapped in cloth for 15-20 minutes
5. Manage pain: Acetaminophen (paracetamol) is preferred; avoid aspirin and NSAIDs initially as they can increase bleeding
6. Do not manipulate: Never attempt to straighten or realign the nose yourself
7. Seek evaluation: Arrange for medical assessment, especially if deformity is visible or symptoms are severe

How Is a Broken Nose Diagnosed?

A broken nose is typically diagnosed through physical examination by a healthcare provider who assesses the nose visually and by gentle palpation. X-rays may be taken but are not always necessary since clinical examination is often sufficient. CT scans are reserved for complex injuries or when other facial fractures are suspected.

The diagnosis of a nasal fracture relies primarily on clinical assessment rather than imaging studies in most cases. An experienced healthcare provider can often determine whether a fracture is present and whether treatment is needed through careful history-taking and physical examination alone.

The clinical evaluation begins with a detailed history of the injury mechanism, including the direction and force of impact, when the injury occurred, and what symptoms have been experienced. This information helps the provider anticipate the type and severity of injury. Previous nasal injuries or surgeries are also relevant, as they may affect the current assessment and treatment planning.

Physical examination involves both external and internal assessment of the nose. Externally, the provider looks for swelling, bruising, deformity, and asymmetry. Gentle palpation can reveal tenderness, instability, or crepitus (a crackling sensation indicating bone fragments). However, examination may be limited immediately after injury due to swelling and pain, which is why follow-up examination after 3 to 5 days is often recommended.

Internal examination using a nasal speculum or endoscope allows visualization of the nasal septum and internal structures. This is particularly important for identifying septal hematoma, septal deviation, and mucosal tears. A septal hematoma appears as a smooth, bluish swelling on the septum and requires immediate treatment to prevent cartilage damage.

Imaging Studies

Imaging is not routinely required for diagnosing nasal fractures but may be useful in specific circumstances:

• Plain X-rays: Can confirm fractures but often don't change management decisions. Many healthcare providers rely on clinical examination alone for straightforward cases.
• CT scan: Reserved for cases where other facial fractures are suspected, when there's significant facial trauma, or when planning for complex surgical repair.
• MRI: Rarely needed for nasal fractures but may be used if soft tissue complications are suspected.

How Is a Broken Nose Treated?

Treatment depends on fracture severity. Minor non-displaced fractures heal with conservative care including pain management and cold compresses. Displaced fractures may require closed reduction (manual realignment) or surgery. Treatment should ideally occur within 1-2 weeks of injury before bones begin to heal in displaced positions.

The treatment approach for a nasal fracture depends on several factors, including the degree of displacement, the presence of complications, functional impairment, and cosmetic concerns. Not all fractures require active intervention, but timely evaluation is essential to ensure appropriate treatment when needed.

Conservative management is appropriate for fractures with minimal or no displacement. This approach focuses on symptomatic relief and allowing natural healing to occur. Elements of conservative care include rest, cold application in the first 48 hours, keeping the head elevated (especially during sleep), avoiding activities that could re-injure the nose, and pain management with over-the-counter medications.

Pain management typically involves acetaminophen (paracetamol) as the first-line option. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be used after the first day or two once bleeding risk has decreased, as they provide both pain relief and anti-inflammatory effects. Prescription pain medications are rarely necessary but may be appropriate for severe injuries.

Closed Reduction Procedure

When the nasal bones are displaced but the injury is relatively straightforward, closed reduction may be performed. This procedure involves manually repositioning the bones without making surgical incisions. It is typically performed under local anesthesia, though sedation or general anesthesia may be used in some cases.

The procedure involves the provider using specialized instruments inserted into the nose to lift and reposition displaced bone fragments. External manipulation helps achieve proper alignment. After reduction, nasal packing may be placed inside the nose to support the repositioned bones, and an external splint is usually applied to maintain position during initial healing.

Timing is critical for closed reduction. The procedure is most effective when performed within 10 to 14 days of injury, before significant healing begins. If performed too early (within the first few days), swelling may make accurate assessment difficult. If delayed beyond two to three weeks, bones may begin to heal in their displaced position, making closed reduction impossible.

Surgical Treatment

Surgery becomes necessary when closed reduction is not possible or when there are complications requiring open surgical repair. Surgical options include:

• Open reduction: Required for complex fractures that cannot be adequately repositioned through closed techniques
• Septoplasty: Corrects significant septal deviation that impairs breathing
• Rhinoplasty: May be needed for cosmetic reconstruction, typically performed after initial healing

What Are the Possible Complications of a Broken Nose?

Complications include septal hematoma (requiring emergency drainage), permanent nasal deformity, chronic nasal obstruction, recurrent nosebleeds, and infection. Septal hematoma is the most urgent complication as it can cause permanent cartilage damage within 24-48 hours if untreated.

While most nasal fractures heal without significant long-term problems, certain complications can occur that may require additional treatment. Understanding these potential complications helps in recognizing when to seek further medical attention and underscores the importance of appropriate initial evaluation.

Septal hematoma is the most serious acute complication and constitutes a true emergency. It occurs when blood collects between the septal cartilage and its overlying tissue (perichondrium), which supplies blood to the cartilage. Without this blood supply, the cartilage can begin to die within 24 to 48 hours, leading to a condition called septal perforation or saddle nose deformity. Symptoms include severe nasal obstruction, visible swelling within the nose, and worsening pain. Treatment requires immediate drainage of the blood collection.

Nasal deformity is perhaps the most common long-term complication, particularly when displaced fractures are not properly treated. The nose may heal in a crooked position, causing both cosmetic concerns and functional problems. While minor asymmetry may be acceptable to some patients, significant deformity typically requires corrective surgery (rhinoplasty), which is more complex than initial fracture treatment.

Chronic nasal obstruction can persist even after fractures have healed, especially if there is underlying septal deviation or if scar tissue develops. Patients may experience ongoing difficulty breathing through one or both nostrils, which can affect sleep quality, exercise tolerance, and overall quality of life. Treatment options include nasal sprays, septoplasty, or other surgical interventions.

Other Potential Complications

• Infection: Can occur particularly if there are open wounds or with internal packing; signs include increasing pain, fever, and discharge
• Recurrent nosebleeds: More common in the weeks following injury due to healing mucosa and newly formed blood vessels
• Anosmia: Loss of smell sense, usually temporary but occasionally permanent with severe injuries
• Cerebrospinal fluid leak: Rare but serious complication indicating skull base fracture

What Is the Recovery Timeline for a Broken Nose?

Initial swelling subsides within 1-2 weeks, while bone healing takes 3-6 weeks. Full recovery with final cosmetic results may take several months. External splints are removed after about one week if surgery was performed. Contact sports should be avoided for at least 6 weeks.

Recovery from a nasal fracture is a gradual process with distinct phases. Understanding the typical timeline helps set realistic expectations and guides activity modifications during healing. While individual recovery varies based on injury severity and treatment received, most people can anticipate the following general progression.

During the first week, swelling and bruising are at their peak. Pain typically decreases significantly after the first few days but may persist at lower levels. If surgery was performed, nasal packing is usually removed within 2 to 3 days. Breathing through the nose remains difficult due to swelling and any residual packing. Most people take time off work during this initial period, particularly if their occupation involves physical activity or public interaction.

During weeks two and three, swelling continues to decrease noticeably. If an external splint was placed, it is typically removed around day 7 to 10. The nose begins to take on a more normal appearance, though subtle swelling may persist. Many people return to work and normal daily activities during this period, though physical restrictions continue. Nasal breathing typically improves significantly.

Bone healing occurs primarily during weeks three through six. While the nose may look relatively normal externally, the bones are still consolidating and remain vulnerable to re-injury. This is why contact sports and high-risk activities are restricted during this period. By six weeks, most fractures have healed sufficiently to allow return to full activities.

Recovery Milestones

How Can You Prevent Nasal Fractures?

Prevention strategies include wearing appropriate protective gear during sports (helmets with face guards, athletic face masks), using seatbelts in vehicles, securing rugs and removing tripping hazards at home, and being aware of surroundings during physical activities. Proper technique in contact sports also reduces injury risk.

While not all nasal fractures can be prevented, many result from situations where appropriate precautions could significantly reduce risk. Understanding the common causes of nasal fractures enables targeted prevention strategies for different populations and activities.

Sports-related prevention is particularly important given the high incidence of nasal fractures among athletes. For contact sports like football, hockey, and lacrosse, helmets with face guards provide essential protection. In sports where full helmets aren't used, such as basketball and soccer, athletic face masks or shields can be worn, particularly by athletes with previous nasal injuries. Proper technique training in martial arts and boxing helps minimize inadvertent facial strikes during training.

Motor vehicle safety measures, including consistent seatbelt use and proper child car seat installation, reduce the risk and severity of facial injuries during accidents. While airbags provide protection, they are designed to work in conjunction with seatbelts, not as a substitute. Motorcycle and bicycle helmets with face shields provide additional protection for these higher-risk transportation modes.

Home safety modifications can prevent falls that lead to facial injuries, particularly in households with young children or elderly individuals. Securing loose rugs, installing adequate lighting on stairs, using non-slip mats in bathrooms, and removing clutter from walkways all reduce fall risk. For older adults, balance exercises and regular vision checks help maintain stability and prevent falls.