Nose, Fractured

The most common facial fracture, a fractured nose usually results from blunt injury and is often associated with other facial fractures. The severity of the fracture depends on the direction, force, and type of the blow.

A severe, comminuted fracture may cause extreme swelling or bleeding that may jeopardize the airway and require tracheotomy during early treatment. Inadequate or delayed treatment may cause permanent nasal displacement, septal deviation, and obstruction.

Causes

In low-energy injuries, non-comminuted nasal bone fragments are caused by low-velocity trauma. Such injuries could occur in the following situations:

• injuries created during fistfights (hand or fist blows only, no blunt instruments) .
• uncomplicated falls, such as tripping .
• low-velocity motor vehicle collision

In high-energy injuries, a higher amount of energy is absorbed by the nasal-facial skeleton, with comminution of bone fragments and associated injuries to the soft tissue and orbital-facial skeleton. These injuries would include:

• injuries sustained from a leveraged blow to the nose using an object such as a stick, pipe, or other blunt object
• falls from heights
• sport injuries with fast-moving projectiles, such as a ball or puck
• high-velocity motor vehicle collisions.

Signs and symptoms

• pain
• blood coming from the nose
• bruising around the eyes
• misshapen appearance (may not be obvious until swelling subsides)
• signs of trauma
• swelling
• difficulty breathing through the nose

Diagnosis

Treatment

Treatment restores normal facial appearance and reestablishes bilateral nasal passage after swelling subsides. Reduction of the fracture corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose and taped) maintains it. Reduction is best accomplished in the operating room under local anesthesia for adults and general anesthesia for children.

First Aid

1. Reassure the victim and try to keep the victim calm.
2. Have the victim breathe through the mouth and lean forward in a sitting position in order to keep blood from going down the back of the throat.
3. Apply cold compresses to the nose to reduce swelling. If possible, the victim should hold the compress so that excessive pressure is not applied.

Prevention

• Protective headgear should be worn while playing contact sports, riding bicycles, skateboards, roller-skates, or roller blades.
• DO NOT try to straighten a broken nose.
• Seatbelts and appropriate car seats should be used.