Nasal Fracture

Any crack in the bone or cartilage of your child’s nose is considered a fractured, or broken, nose. The bone is the bridge of the nose, and the cartilage includes the septum, or wall inside the nose that divides the nostrils. Because the nose sticks out, it’s vulnerable to fracture when your child falls or plays sports, for instance. Roughly half of all facial fractures are broken noses. 

In most cases a broken nose causes a bent, or crooked, nose and changes in breathing.  If the doctor doesn’t reposition the bones within two weeks, your child’s nose will heal crooked and need a formal reconstruction to correct it.

You can’t always tell if your child’s nose is broken just by looking at it. Swelling can obscure whether it’s bent or not. That is why it is best to evaluate the nose five to seven days after the injury when swelling has decreased. But a nose can also be broken but not bent, if the break was minor.

A broken nose can also cause more serious problems, such as a septal hematoma, which is a blood clot that forms within the wall inside the nose. If not drained, this clot could lead to a serious infection. Other complications include a hole in the nasal septum (septal perforation) that can cause the bridge to collapse.

To reduce the risk of complications, a suspected nasal fracture should always be checked out by your primary care provider right away, regardless of how much swelling, bleeding or pain it causes. 

A sudden impact to your child’s nose or face is the most common cause of a fracture. The typical ways this happens in childhood include:

• An accident, like falling off a bike or walking into a wall
• Contact sports, like basketball and hockey
• Car accidents

A child’s symptoms can vary depending on the degree of the break. A broken nose generally causes any of these symptoms:

• Pain
• Nosebleeds
• Blocked nasal passages and difficulty breathing
• Swelling of the face
• Bruises around the eyes — a look of “black eyes”
• A crooked nose
• Tenderness when touching the nose
• A grating or crunching sound when touching the nose

Take your child to the ER right away if he has any of these symptoms, which could signal additional, more serious problems like a concussion or spinal injury:

• Bleeding from the nose that doesn’t stop
• Clear fluid draining from the nose
• Loss of consciousness
• Severe headaches
• Repeated vomiting
• Change in vision
• Neck pain
• Numbness or weakness in the arms

Your primary care provider may examine your child but will likely refer him to a specialist.  While a primary care provider can evaluate a broken nose and offer pain and infection management, he or she may not be trained in repositioning the bones or managing complications. An otolaryngologist (ear, nose and throat specialist), is generally recommended to diagnose, manage and fix a broken nose. To diagnose a broken nose and assess the extent of damage, he or she may:

• Conduct a physical exam, including a thorough inspection of the face, head and neck.
• Take a medical history, especially details surrounding the injury and the appearance of your child’s nose prior to the injury.
• Use a lighted instrument, called a nasal speculum, to inspect the nostrils and the nasal septum and to check for blockages and complications, like a septal hematoma.
• Obtain an X-ray or CT scan to determine whether there are other facial or jaw fractures. These scans generally aren’t used to confirm a broken nose.

Depending on the degree of the break, a specialist may recommend:

• A regimen of applying ice and keeping your child’s head elevated to reduce swelling. Extra pillows at night might be recommended.
• Pain medication, such as acetaminophen (aspirin and ibuprofen are not recommended because they are blood thinners and can make bleeding worse).
• Packing placed in the nostrils, or a soft gauze pad in the bleeding nostril to stop the nosebleed.
• Antibiotics, especially if packing is placed in the nostrils.
• Rest and protection of your child’s nose; if the bones aren’t out of place, this regimen of rest may be all that’s recommended until the swelling subsides completely and the nose has fully healed.
• A repositioning of the bones, if the septum is deviated, using general anesthesia. This repair, known as a “reduction,” may be done a few days after the fracture, when swelling has subsided somewhat. The bones will then be held in place for about a week with a splint.

If a nasal fracture is evaluated and treated right away, your child’s nose will likely heal, return to its normal size and shape, and function normally. This is true even with a significantly deviated septum, which can be repaired successfully. If a nasal fracture is not repaired within two weeks, then a reconstructive surgery may need to be performed several months later. If a broken nose is left untreated, a child can have permanent changes in breathing, a susceptibility to sinus infections, and a nose that looks misshapen or different from his original nose. 

After the specialist treats your child’s fracture, he or she will want to see your child again within the first week following the treatment, to make sure his nose is healing properly and that no complications have developed. During the period of healing, your child will need to rest more than usual. You may need to follow a regimen of applying ice to the area for a few days, to decrease pain and swelling. Your doctor will also show you how to care for any splints or packing. Your child may need to avoid blowing his nose for a long period of time, too.

The team of otolaryngologists at CHOP are expertly trained in diagnosing, managing, and treating a broken nose and restoring it to its original shape, regardless of the severity of the fracture. They are highly specialized in the care of any disorder that affects a child’s nose, head and neck. They can properly manage serious complications, use the latest surgical techniques, and produce the best and most cosmetically desirable outcomes. Our large team of trained nurse practitioners and secretaries will also be able to provide immediate assistance over the phone and help determine the next best step for evaluation and treatment.