Fractured or Broken Nose? : Nose Surgery may help

Broken nose Blog on Coco Ruby - Woman Holding Her Nose

Surgery Solutions for a Fractured or Broken Nose in Melbourne or Sydney Australia

Besides it being our primary smelling organ as well as a part of our body’s respiratory system, the nose has long been considered an important part of human beauty, and overall facial harmony. This is inevitable as it’s the most protruding part of our face, sitting front and centre its no wonder it quite literally “stands out”. Unfortunately, the nose’s prominent yet unprotected position leaves it vulnerable to accidents and assaults. An injured nose can not only alter your appearance but can cause more serious problems like breathing difficulties. A nasal fracture often heals on its own, however, sometimes surgery may be necessary to help realign the bones and reshape your nose (rhinoplasty).

Here at Coco Ruby, we have a team of Melbourne-based specialist surgeons, with years of experience in procedures such as Rhinoplasty and Septoplasty. We tailor our plastic surgery planning to deal with your aesthetic concerns regarding your broken nose, as well as helping you achieve functional improvement.

Keep reading to learn more about nasal fractures and the best ways to fix them.

What is a broken nose?

First, to understand nasal fractures better, check out our article on nose anatomy and common glossary terminology.

A broken nose, also known as nasal or nose fracture is a break or crack in the bones of the nose. It often occurs over the nasal bridge and includes nearby cartilage (the soft parts of your nose), especially the septum. The nasal septum is the flexible wall that divides your left and right nostrils on the inside. A fractured can range in severity. A milder fracture can present with minimal swelling or a brief nosebleed. A person may remain unaware of the break until it heals with a slight deformity. Severe fractures, however, present with a hard to miss deformity. The nose often shifts from its normal midline position right after impact (As pictured below). Moreover, a break of this magnitude can be accompanied by heavier nosebleeds, a blocked nostril, or even impaired airflow.

What causes a broken nose?

As previously mentioned, the nose’s anatomy and position make it a prime target for various injuries. Broken noses make up to 40% of facial fractures. Therefore, any activity that has the potential to cause a facial injury, subsequently, increases the risk of a broken nose occurring. Below are some of the most common causes for a fractured nose;

  • Contact sports: These are sports that cannot be undertaken without physical contact between players. Acquiring a nose injury is very common in rugby, hockey, and American football.
  • Physical fights: In any form, be it on a professional level (boxing, MMA, UFC, etc…) or regular altercations.
  • Motor vehicle accidents: Driving a car without a seat belt or riding a bike without protective gear also significantly increase your chances of nose trauma.
  • Falls: A broken nose can be a result of a fall, from either a bike, skateboard, rollerblades, or pure clumsiness.

It is important to note that due to their immature bones being somewhat flexible, children carry a lower risk of nasal fractures. However, if they do fracture their nose, they are more likely to suffer from long-term deformities and breathing difficulties. In newborns, traumatic nasal injuries can occur during delivery. Toddlers can fall on their face when learning to walk, or even afterwards. In older children, a nose fracture is likely to occur for the reasons listed earlier. Unfortunately, facial fractures are also common in child abuse victims.

How do you prevent a broken nose?

While sustaining a nose injury is sometimes inevitable, there are certain steps you can follow to help minimize the risk of nasal fracture;

  • Seat belt: Being buckled up whilst in the car helps keep you safe in the event of a car accident. It reduces the risk of suffering from a smashed nose by nearly half. Seatbelts are for everyone, so always make sure younger children are in age-appropriate child safety seats as well.
  • Helmets: Sports that carry a significant risk for head and nose injuries (American football, bicycling, hockey) often mandate the use of helmets as part of the uniform. Furthermore, you should ALWAYS wear a helmet when on a motorcycle.
  • Protective gear: In sports like rugby, professional fighting, basketball, and soccer, a faceguard is always an option to protect your face from nasal injuries as well as maxillary, zygomatic, and orbital bone fractures.

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How to tell if your nose is broken?

Signs and symptoms of a fractured nose can appear immediately after impact or can take up to 3 days to show. Swelling can make an accurate assessment of the extent of nose damage difficult. Other symptoms include:

  • Pain: Especially when touching your nose. It can be accompanied by a crunching sound (called crepitus)
  • Bruising: Discolouration may appear around your nose and eye area. This is due to capillary disruption, and the accumulation of blood beneath the skin’s surface.
  • Nosebleeds: These can range in severity. A heavy or continuous blood flow is a warning sign to seek immediate professional help.
  • Rhinorrhea: Is another medical emergency. A clear discharge from your nose may signify leakage of cerebrospinal fluid (brain fluid). This usually happens due to the disruption of the thin fovea ethmoidalis, a bony plate that forms part of your skull base, separating the brain from the sinuses.
  • Breathing difficulties: This can be a direct result of either nose swelling, dried blood or a deviated septum.
  • Crooked nose: You may notice that your nose has taken a misshapen look and is no longer as straight as before.

How is a broken nose diagnosed?

If your nasal injury is not severe, accompanied only by mild swelling and pain, it’s best to allow your swelling to subside. This will allow you and your doctor to better assess your nose injury. Please note that you should not wait longer than a week before seeking medical advice. Severe nose trauma requires more prompt medical attention.

During your appointment, your doctor will gently prod your nose and surrounding areas. They will examine your nasal passage to check for signs of further bone damage or obstruction. Your doctor may use Anesthetics (nasal spray or local injections) to make the physical exam more comfortable. You will be asked how you sustained your injury, your medical and surgical history, allergies, and your current medications.

X-rays are rarely needed to diagnose a broken nose. However, your physician may implement a computerized tomography (CT) scan if your nasal injuries are so severe that physical examination is impossible, or if they suspect multiple injuries.

Dr Kleid does not routinely recommend scans or Xrays. A crack in the bone where the nose hasn’t shifted (undisplaced fracture) can be difficult to diagnose, and since it does not require treatment, attempting to make the diagnosis is not worthwhile.

What are the possible complications of a broken nose?

The aftermath of a nasal fracture can range in severity. Below are some possible complications of a broken nose;

  • Deviated septum: A common complication of a broken nose. The nasal septum is the thin wall inside your nose that separates your right and left nostrils. Septal deviation occurs when your nasal septum is displaced. This leads to a narrowing of your airways and can cause breathing difficulties.
  • Deviated external nose – this can usually be easily straightened within 10-14 days, or the nose will remain deviated, unless formal Rhinoplasty is performed.
  • Septal hematoma: This is when blood pools and collects in a broken bone, blocking one or both nostrils. This is an emergency condition that requires immediate surgical drainage to prevent cartilage injury.
  • Septal hematoma: Can lead to a septal perforation, and/or saddle nose. If a infection occurs it can lead to a septal abscess.
  • Cartilage fracture: Cartilage is the soft compressible part of your nose. It can be smashed as a result of a forceful impact, most often from a motor vehicle accident. Severe nose injury may warrant surgical intervention (rhinoplasty).
  • Infection: Disruption of the nasal architecture leaves the nose prone to bacterial invasion. This could spread to nearby sinuses, facial bones, and even your brain (meningitis).
  • Altered sense of smell: All nose fractures carry the risk of olfactory impairment. This can range from a decrease in smell detection ability (hyposmia) to a complete lack of smell (anosmia).

Dr Kleid fixes most nasal fractures under local anaesthetic (injections) in a chair. However, some cases require or may prefer a full general anaesthetic in hospital.

How to manage a broken nose at home?

If your nose injury doesn’t warrant immediate medical attention and is not causing significant problems, it is safe to follow these suggestions before seeing a doctor:

  • Ice packs: Apply a pack of ice wrapped in a towel or its equivalent (bag of frozen peas) on your fractured nose for 15 mins, several times a day.
  • Pain relief: You may use over the counter medication such as paracetamol or ibuprofen for symptom control.
  • Nosebleed control: Sit down, lean forward, and pinch the soft part of your nose above the nostrils – only if possible. Avoid tilting your head backwards as is common, this will drain blood into the back of your throat.
  • Swelling reduction: To ease nose swelling, keep your head upright by stacking pillows when lying down.

In addition to these self-care tips, there are some important “don’ts” that you should avoid while your nose heals.

  • Don’t feel emboldened to straighten out your nose yourself. Seek out a qualified physician instead.
  • Avoid wearing spectacles until your swelling has gone down significantly.
  • Restrain yourself from blowing or picking your nose. This may exacerbate your injury.
  • For the first 2 weeks, allow your nose to heal properly and avoid any strenuous activity.
  • Don’t participate in any sporting activity for at least 6 weeks. There’s always a chance you might hit your face…again.

How do you treat a broken nose?

If you’ve been in an accident, you will be given emergency care in the emergency room. After addressing the more serious injuries, you will be referred to an ENT or plastic surgeon to assess your broken nose and decide if any intervention is necessary. Below are the possible approaches to use when dealing with a broken nose;

Medications

  • Over the counter medication: This includes analgesics such as acetaminophen (paracetamol) that provide pain relief. You may also use Nasal decongestants to alleviate swelling by constricting mucosal blood vessels.
  • Antibiotics: You may be given a perscription for empiric antimicrobial therapy as prophylaxis. An injured nose is vulnerable to infections.

Minor procedures

  • If the nose is not straight on the outside, it will need to be straightened. Dr Kleid does most of these under local anaesthetic (injections) on his dental chair in his office but occasionally does them in hospital under a General Anaesthetic (asleep).
  • You will not require a nasal pack.

Rarely, your surgeon may need to perform other procedures, including;

  • Debridement: It is the process of removing all thickened, infected, and nonviable tissues and debris. If an open wound is present, a thorough debridement is necessary.
  • Nasal packing: If the bleeding persists, your surgeon may pack your nose with a hemostatic sponge or gauze.
  • Surgical draining: A septal hematoma is a medical emergency. It must be drained or incised with the help of local anaesthesia to prevent serious complications.

Surgery

  • Rhinoplasty: Nasal reconstruction by an experienced surgeon is often needed to repair a broken nose, even after reduction if the aesthetic outcomes of closed reduction techniques are less than desirable. A rhinoplasty allows your surgeon to fix your broken nose and improve its features to meet your desired look.
  • Your surgeon can address other nose issues during the same procedure. For example; a large dorsal hump (bridge), overly projecting tip, or notched nostrils.
  • A nose job uses either; an open technique (small skin incision between your nostrils) or a closed technique (no outer skin incision). This depends on the type of injury and deformity you have and what you want to be done.
  • Septoplasty: Is the surgical correction of defects involving the nasal septum, which is frequently damaged in nose trauma. This improves airflow and breathing.
  • Septorhinoplasty refers to the procedure when both the nasal septum and the nose appearance need correction.

If you require nose surgery – What to expect after Rhinoplasty?

For the majority of patients, the nose will NOT be packed or splinted.

Like any surgical procedure, you should expect some pain, swelling, and bruising. They are most noticeable in the first week after surgery, before starting to fade. Bruising and tenderness can extend to your cheeks and under-eye area, this is not unusual and is the result of inevitable blood vessel damage during the procedure. While this typically starts to resolve within a few days you should take at least 2 weeks off after surgery to allow yourself proper recovery and rest.

Perhaps one of the most crucial things to keep in mind after undergoing a nose job is that the road to full recovery is long. That’s not to say that you won’t notice any changes, initial results start to show within 1 month, as the tissue begins to heal, and the swelling starts to subside.

Unlike other body parts, the soft tissue of the nose tends to retain swelling longer. Therefore, despite noticing remarkable changes within the first few weeks, the final nose contour will take several months, and even up to a year, to emerge. Check out these rhinoplasty nose surgery before and after pictures:

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Your surgeon will provide you with guidance to ensure you get the best possible results. This includes post-operative care, medication schedules, and what signs to look out for.

What are the long-term outcomes of broken nose surgery?

In addition to fixing your nose and preventing complications, broken nose surgery gives you the opportunity to change your nose’s appearance. In the right set of hands, studies have shown that the positive long-term effects of rhinoplasty are not only what is seen on the outside. The remarkable psychological outcome may perhaps exceed any functional or aesthetic benefits. Rhinoplasty can give you the confidence boost you lacked and increase your happiness in life. It allows for a better-perceived self-image that affects how you carry yourself around others as well as how others perceive you.

Will Medicare or private health insurers cover the costs of surgery?

Purely Cosmetic procedures, including cosmetic rhinoplasty, are considered elective surgery. Neither Medicare nor third-party health insurers will cover you. However, if a procedure is considered medically necessary, a Medicare Item Number will be assigned to it ( for more info visit Medicare Benefits Schedule (MBS)), this will make you eligible for some form of subsidy or refund. This also applies to health insurers who will typically reimburse you if a medical or functional component is provided and a medicare item number is provided. Read our blog articles on Medicare for Nose Surgery and Medicare for Rhinoplasty.

A rhinoplasty will qualify for Medicare or third-party providers rebate if the reason for the procedure is either to correct;

  • A nasal obstruction (e.g., deviated septum)
  • A developmental deformity (e.g., saddle, cleft, or bifid nose)
  • Or, post-traumatic nasal injuries. However, the cause of the trauma can not be a result of a previous rhinoplasty.

To claim your Medicare or Insurer refund, you will need to be refferred to an ENT specialist or a plastic and reconstructive surgeon. Here at Coco Ruby, your surgeon will assess your case, and decide whether or not your surgery qualifies as medically necessary. We will provide you with private one-to-one consultations and be there for you every step of the way.

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Broken Nose FAQs – Frequently Asked Questions about a nasal fracture or a Broken Nose

Can an ENT fix a broken nose?

  • Yes, an ENT surgeon specializes in the treatment of nasal trauma as well as cosmetic nose surgery (rhinoplasty).

How painful is a broken nose?

  • Well, it is relative and depends on the degree of your injury. Bone fractures tend to produce more pain and swelling than cartilage fractures.

Does a broken nose require surgery?

  • Not always. If your injury is mild, you might only need a splint.
  • Closed reduction may be necessary if there’s a minor deformity.

What happens if you leave a broken nose untreated?

  • If your nasal injury has dislocated your nasal bones, septum, or cartilage and you leave yourself untreated, you might develop a permanent nose deformity (for example a crooked nose).

Can a broken nose cause problems years later?

  • If you receive proper treatment, your nasal fracture should not cause you any more problems in the future.
  • If you need surgery but decide not to have it, you might end up with a permanent deformity or septal deviation, which can subsequently cause breathing difficulties.

Why do broken noses cause black eyes?

  • Trauma is what usually causes a broken nose. This trauma can damage the vessels in your forehead and around your nose, causing blood to leak.
  • Due to the effect of gravity, blood in this region tends to collect under the eyes, a sign called “raccoon eyes”.

Further Reading – Medical Sources:

 

Last updated: 18/03/2021
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Dr Stephen Kleid
Dr Stephen Kleid is an experienced Ear, Nose and Throat ENT Surgeon (Otolaryngologist) based in Melbourne with a passion for aesthetic nose surgery. rhinoplasty and a strong interest in Rhinoplasty Revision.