Broken and fractured noses

What is a broken nose?

A broken nose, or nasal fracture, is a crack or break in the bone or cartilage (the firm, flexible tissue that gives your nose its shape). It's one of the most common facial injuries, because your nose sticks out from the rest of your face and has little protection.

Symptoms of a broken nose

After an injury to your nose, you might notice:

• pain, swelling and bruising around your nose, sometimes spreading to bruising under your eyes
• a crunching or crackling feeling or sound when you touch your nose
• your nose looking crooked, bent or a different shape to before
• a nosebleed, or cuts on the bridge of your nose
• a blocked feeling or difficulty breathing through your nose
• your nose feeling loose, unstable or clicking when you touch it.

Causes and who is at risk

A broken nose happens when something strikes your face with enough force to crack the bone or cartilage. Because your nose sticks out further than the rest of your face, it's often the first part to take the impact. Common causes include:

• a fall
• a blow during contact sports
• a physical fight or assault
• a road traffic accident.

Are there different types of broken nose?

Not every broken nose is the same. Some are simple, uncomplicated fractures that only involve the nasal bone or cartilage, and these are usually managed with the self-care and follow-up steps described below. Others are more complicated, involving other facial bones such as your cheekbones or eye sockets, or linked with signs of a head injury. Complicated fractures usually need assessment by a specialist.

How is a broken nose diagnosed?

Your doctor or nurse will usually examine your nose and face rather than rely on scans. They'll gently press around the bridge of your nose and look inside your nostrils to check for any blockage, bleeding or blood clots, and make sure you can breathe through both sides.

X-rays aren't usually helpful for confirming a broken nose, because the nasal bones don't show up clearly on them. In fact, plain X-ray images miss around half of all nasal fractures. A scan or X-ray might still be used if your doctor thinks you may have also injured other parts of your face, such as your cheekbones, eye sockets or jaw.

How is a broken nose treated?

Non-surgical treatment

Most broken noses get better on their own with simple care at home:

• hold an ice pack, or a bag of frozen peas wrapped in a tea towel, on your nose for up to 15 minutes, several times a day
• take paracetamol or ibuprofen to help with pain
• prop yourself up on extra pillows in bed, this helps reduce swelling
• you may be given antibiotics if you have a cut, or if a blood clot in your septum (the wall between your nostrils) needs to be drained. This is usually done within 24 hours to lower the risk of damage to the cartilage.

If your nose bleeds

1. Sit up in a neutral postion.
2. Breathe through your mouth.
3. Pinch the soft part of your nose for 15-20 minutes.
4. Hold a cold compress against your nose.
5. Spit out any blood in your mouth rather than swallowing it.

Recovery time

It's sensible to avoid contact sports for at least six weeks, in case your nose is knocked again before the bone has properly set.

Surgical and procedural treatment

If your nose has changed shape, or you're still struggling to breathe once the swelling has gone down, you might be offered a procedure to reset it, called manipulation. This is usually done under local anaesthetic (medicine that numbs your nose without putting you to sleep), so you stay awake. A general anaesthetic (medicine that puts you fully to sleep) is sometimes used instead for more severe injuries.

1. Your nose is numbed with anaesthetic.
2. Your doctor moves the bones and cartilage back into place, usually using their fingers or a special instrument, without needing to cut your skin.
3. Gauze packing may be placed inside your nose, with a splint or dressing on the outside to hold everything in position.
4. You may be given antibiotics to help prevent infection.
5. The packing and splint are usually removed after around one to two weeks.

This procedure needs to happen before the bones start to set which is generally 1-2 weeks after the injury occurs.

For more serious injuries, for example if your septum is damaged or your breathing doesn't improve, you might need an operation called a septoplasty to reshape the wall between your nostrils, or a rhinoplasty to reshape the outside of your nose.

When should I see a doctor?

Contact NHS 111 or your GP if:

• your nose still looks crooked or bent a few days after the injury
• swelling hasn't started to go down after about three days
• painkillers aren't controlling the pain
• you're still finding it hard to breathe through your nose once the swelling has gone
• you keep getting nosebleeds
• you feel feverish, hot, cold or shivery
• your nose still hurts or is swollen several weeks after treatment.

Call 999 or go to A&E straight away if:

• you lost consciousness, were sick, or can't remember the injury
• you have bleeding from your ear, or clear, watery fluid coming from your nose. This can be a sign of a more serious head injury
• you have a large cut, or something is stuck in the wound, such as glass
• you have a severe headache with blurred or double vision
• you have neck pain or stiffness with tingling or numbness in your arms or legs
• there's purple, painful swelling inside your nose
• you take blood-thinning medicine, such as warfarin, apixaban or rivaroxaban, and your nose is bleeding
• your nosebleed will not stop.

If you need to go to A&E, ask someone to drive you, or call 999 for an ambulance, rather than driving yourself.