Nasal Injury
A broken nose.
The nose is the most commonly broken bone in the face, and most fractures heal without any intervention. The ones that leave a new bend or a blocked airway are best assessed early, because the window in which the bones can simply be repositioned closes within about two weeks of the injury.
General education only. Your diagnosis, options and coverage are individual, and are established at your consultation.
The Injury
What happens when the nose is broken.
The upper part of the nose is bone; the lower two thirds are cartilage. A blow from the side pushes the nasal bones over, so the bridge looks bent; a blow from the front can flatten or widen it. The septum inside is often bent or displaced at the same time, which is why a fractured nose so often breathes worse afterwards even when it looks straight. In the first days everything is obscured by swelling: a nose that looks crooked may simply be swollen unevenly, and one that looks fine may be hiding a displacement. That is why the assessment that matters happens a few days after the injury, not on the day.
Two complications need to be recognised early. A septal hematoma is a collection of blood inside the septum, felt as a soft, painful swelling blocking both nostrils; untreated, it can destroy the cartilage within days and leave the nose collapsed. And a clear, watery drip from the nose after an injury can mean a leak of the fluid around the brain through a fracture at the base of the skull. Both belong in an emergency department, not on a waiting list.
X-rays of the nose are rarely useful: they miss cartilage entirely, they often miss the fracture, and they do not change what is done, which is decided on how the nose looks and breathes. A CT scan is ordered when other facial fractures are suspected.
Signs that the nose may be broken
- Swelling and bruising across the nose and under the eyes
- A nose that looks bent, flattened or widened once the swelling settles
- Breathing through one or both sides that is worse than before the injury
- A nosebleed at the time of injury
- A grating feeling or sound when the nose is touched
- Pain and tenderness over the bridge
Having several of these does not confirm the diagnosis, and having few does not exclude it. The examination does that.
Timing
Why the first two weeks matter.
Broken nasal bones begin to knit within days and are largely fixed in place within about two weeks in adults, sooner in children. Inside that window, displaced bones can be repositioned by manipulation, a closed reduction, without any incision. Once the bones have set, straightening the nose means a formal operation, a septorhinoplasty, which breaks and resets them deliberately, and which is best done months later once the tissues have healed completely.
The practical sequence is therefore: control bleeding and swelling on the day, exclude the emergencies, and then have the nose examined at around three to five days, when the swelling has settled enough to see the true shape. If there is a new deformity or a new obstruction, the decision about repositioning is made then, with time to spare. Ask your physician or walk-in clinic to fax the referral marked "urgent: nasal fracture" with the date of injury, and to call the office the same day.
Day one
Cold compresses, head elevated, no nose-blowing, simple pain relief as advised. See a physician promptly if bleeding does not stop or the emergency signs below appear.
Days three to five
The assessment that matters: is the nose straighter or narrower than before? Is the septum displaced? Has a hematoma been excluded?
Up to about two weeks
The window for closed reduction, repositioning the bones by manipulation, in adults. In children the window is shorter.
Months later
If a deformity or obstruction remains after healing, a septoplasty or septorhinoplasty is planned once the tissues have fully settled.
Assessment First
How a fractured nose is assessed.
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The injury
How it happened and when, whether the nose looked and breathed the same before, whether there was loss of consciousness, and any previous injuries or operations.
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Examination
The shape of the nose from the front and from above, the position of the bones, tenderness and mobility; the inside of the nose for the septum, a hematoma, and the airway; and the eyes and face for other injuries.
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Photographs
Standardised clinical photographs may be taken, both to plan and to record the injury; they are part of your record and are never published.
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The decision
Whether the fracture is displaced enough to warrant repositioning, whether the septum needs attention, and whether it is best done now under local anesthetic, now under general anesthetic, or deferred and planned properly later.
Your Options
The options, with their trade-offs.
Decided once the swelling allows an honest look. Set out side by side so you can weigh them yourself.
| Option | What it involves | Trade-offs to weigh |
|---|---|---|
| No intervention | For fractures that are undisplaced, or displaced so little that the nose looks and breathes as it did before. The majority of nasal fractures. | Nothing is done and nothing is risked. If a subtle deformity or obstruction becomes apparent later, it can still be addressed. |
| Closed reduction | Repositioning the nasal bones by manipulation within about two weeks of injury, under local or general anesthetic depending on the fracture and on you, usually with a splint for about a week afterwards. OHIP-insured. | Restores the position in many cases but not all: the bones can settle slightly as they heal, and the septum is not always fully corrected. A later operation is sometimes still needed. |
| Delayed septoplasty | For a septum displaced by the injury that leaves the airway blocked after healing, straightened through the nostrils months later. Generally OHIP-insured when medically indicated. | An operation, with the risks of any septoplasty. Improves breathing; does not change the outward shape of the nose. |
| Delayed septorhinoplasty | For a nose left bent or collapsed after healing: the bones and cartilage are reset and rebuilt deliberately, typically months after injury, with the airway corrected in the same operation. | Larger surgery with a staged recovery and a result that refines over months. The breathing component is generally insured when medically indicated; a purely cosmetic component is not, and the two are separated clearly in writing. |
If a previous injury left your nose bent or blocked years ago, it is never too late to be assessed. The timing rules above apply only to repositioning a fresh fracture.
Go to an emergency department for
Bleeding that does not stop with ten to fifteen minutes of firm pressure on the soft part of the nose; a soft, painful swelling blocking both nostrils (a possible septal hematoma); clear watery fluid dripping from the nose; double vision, a change in vision or an eye that looks different; numbness of the cheek; a wound over the bridge exposing bone; loss of consciousness, confusion, vomiting or a severe headache after the injury. These are assessed the same day, not by referral.
Common Questions
Nasal Fracture, answered plainly.
Usually not. Plain X-rays of the nose miss cartilage, often miss the fracture, and do not change what is done, which is decided on how the nose looks and breathes once the swelling has settled. A CT scan is ordered when other facial fractures or a skull base injury are suspected.
Too late for simple repositioning, which needs to happen within about two weeks, but not too late to be treated. Once the bones have healed, a bent or blocked nose is corrected with a planned operation, a septoplasty or septorhinoplasty, usually several months after the injury when the tissues have fully settled. It is never too late to be assessed.
Often, after a well-timed reduction, though not always exactly: bones can settle slightly as they heal, and cartilage has its own memory. Where a deformity remains, it can be addressed later. What the practice will not do is promise a result; it will tell you what is likely, and what the options are if it falls short.
Because the septum inside was probably displaced at the same time, which is common. A straight-looking nose with a blocked airway is assessed for the septum and the nasal valve, and if the obstruction persists after healing, a septoplasty corrects it through the nostrils without changing the outside.
Children are assessed sooner, because their bones set faster and the window for repositioning is shorter, about a week. Septal hematoma is a particular concern in children and is looked for specifically. Because the nose is still growing, surgery beyond repositioning is approached conservatively and often deferred.
Assessment first. Then the options are yours.
An OHIP-insured assessment begins with a referral from your physician or nurse practitioner. The office contacts you once it is received.