Nose fracture

Answer 1

Definition

A nose fracture is a break in the bone or cartilage over the bridge, in the sidewall, or septum (line dividing the nostrils) of the nose.

Alternative Names

Fracture of the nose; Broken nose

Considerations

A fractured nose is the most common fracture of the face. It usually occurs after an injury and often occurs with other facial fractures.

Sometimes, as a result of a blunt injury, the wall dividing the nostrils (septum) can separate.

Nose injuries and neck injuries are often seen together because a blow that is forceful enough to injure the nose may be hard enough to injure the neck.

Serious nose injuries cause problems that require a doctor's attention right away. For example, damage to the the lining of the septal cartilage can result in a collection of blood forming inside the nose. If not drained promptly, this can result in an abscess or a permanent deformity that causes a nasal blockage. It may ultimately result in tissue death and collapse of the nose itself.

However, for minor nose injuries, the doctor may prefer to see the patient within the first week after the injury if the nose may have become deformed.

Occasionally, surgery may be needed to correct a deformity of the nose or septum caused by a trauma.

Symptoms

• Blood coming from the nose
• Bruising around the eyes
• Difficulty breathing through the nose
• Misshapen appearance (may not be obvious until swelling goes down)
• Pain
• Swelling

The bruised appearance usually disappears after 2 weeks.

The symptoms may be the same as those of a fractured nose.

First Aid

1. Reassure the patient and try to keep the patient calm.
2. Have the patient 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 patient should hold the compress so that there isn't too much pressure on the nose.
4. To help relieve pain, acetaminophen (Tylenol) is recommended.

Do Not

• Do NOT try to straighten a broken nose.
• Do NOT move the person if there is reason to suspect a head or neck injury.

Call immediately for emergency medical assistance if

Get medical help right away if:

• Bleeding will not stop
• Clear fluid keeps draining from the nose
• You suspect a blood clot in the septum
• You suspect a neck or head injury
• The nose looks deformed
• The person is having difficulty breathing

Prevention

Wear protective headgear while playing contact sports, riding bicycles, skateboards, roller skates, or rollerblades.

Use seat belts and appropriate car seats when driving.

References

Drezner JA, Harmon KG, O'Kane JW. Sports medicine. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 41.

Riviello RJ. Otolaryngologic procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2004:chap 65.

Belleza WG, Kalman S. Otolaryngologic emergencies in the outpatient setting. Medical Clinics of North America. March 2006;90(2):329-353.

Answer 2

Definition

A nose fracture is a break in the bone or cartilage over the bridge, or in the sidewall or septum (structure that divides the nostrils) of the nose.

Alternative Names

Fracture of the nose; Broken nose; Nasal fracture

Considerations

A fractured nose is the most common fracture of the face. It usually occurs after an injury and often occurs with other fractures of the face.

Sometimes a blunt injury can cause the wall dividing the nostrils (septum) to separate.

Nose injuries and neck injuries are often seen together because a blow that is forceful enough to injure the nose may be hard enough to injure the neck.

Serious nose injuries cause problems that need a health care provider's attention right away. For example, damage to the cartilage can cause a collection of blood to form inside the nose. If this blood is not drained right away, it can cause an abscess or a permanent deformity that blocks the nose. It may lead to tissue death and cause the nose to collapse.

For minor nose injuries, the health care provider may want to see the patient within the first week after the injury to see if the nose has moved out of its normal shape.

Occasionally, surgery may be needed to correct a nose or septum that has been bent out of shape by an injury.

Symptoms

• Blood coming from the nose
• Bruising around the eyes
• Difficulty breathing through the nose
• Misshapen appearance (may not be obvious until the swelling goes down)
• Pain
• Swelling

The bruised appearance usually disappears after 2 weeks.

First Aid

1. Try to stay calm.
2. Breathe through your mouth and lean forward in a sitting position to keep blood from going down the back of your throat.
3. Apply cold compresses to your nose to reduce swelling. If possible, hold the compress so that there isn't too much pressure on the nose.
4. To help relieve pain, acetaminophen (Tylenol) is recommended.

Do Not

• Do NOT try to straighten a broken nose.
• Do NOT move the person if there is reason to suspect a head or neck injury.

Call immediately for emergency medical assistance if

Get medical help right away if:

• Bleeding will not stop
• Clear fluid keeps draining from the nose
• You suspect a blood clot in the septum
• You suspect a neck or head injury
• The nose looks deformed or out of its usual shape
• The person is having difficulty breathing

Prevention

Wear protective headgear while playing contact sports, riding bicycles, skateboards, roller skates, or rollerblades.

Use seat belts and appropriate car seats when driving.

References

Chegar BE, Tatum SA III. Nasal fractures. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 35.

Riviello RJ. Otolaryngologic procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 64.

McKay MP, Mayersak RJ. Facial trauma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 39.

Reviewed By

Review Date: 08/31/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.