Soccer fans across the United States were thrilled with the US team’s opening game victory against Ghana. For those watching the game live, along with a great match, they also witnessed US star Clint Dempsey suffer a blow to the nose and a possible nasal fracture. While active Americans suffer many of the same injuries as their sport heroes, injuries to the nose and face are common for weekend warriors along with the parents of children involved in sports. The bleeding and possible disfigurement associated with facial trauma and nasal fractures can be a cause of great anxiety for patients or the parents of injured children.

The nasal bones are the most common facial bones to be fractured and nasal fractures are the third most commonly occurring fracture in the body. The injury is 2-3 times more common in males, most often occurring in patients between the ages of 15-40 years old. The most common causes are accidents, altercations and sports. Among nasal fractures occurring during sports games, soccer accounts for highest percentage of nasal injures (40 percent). In younger children, sport related injuries are the leading cause of broken noses, accounting for 65 percent of all nasal fractures.

The nose is the most prominent feature on the face. Along with its overlying skin, it is comprised of paired nasal bones at the top and paired cartilaginous elements at the bottom. The nasal septum is also comprised of both bone and cartilage. Nasal fractures typically involved injury to both the bony and cartilaginous elements of the nose. Bleeding often occurs at the time of injury and can be impressive. It can usually be stopped by holding pressure (pinching the nose) or by he placement of nasal packing by trained medical professionals (as was done for Clint Dempsy during the match with Ghana). Swelling of the nose soon follows, along with bruising, especially underneath the eyes.

A broken nose can often be diagnosed based on a clinical exam. In fact, most patients complaining of a broken nose are keenly aware of the change in the appearance of their nose and/or increased problems with nasal breathing. X-rays are well known for being unable to accurately detect nasal fractures. CT scans can be more useful but are usually only needed to fully evaluate the face for any other broken bones or injuries. While many patients are unhappy with the appearance of their nose after it has been fractured, the nasal obstruction that often results can be especially bothersome and will often drive them to seek medical attention.

Once diagnosed, there many options treatment for broken noses. In the early period after the injury the bones can sometimes be manually pushed back in place (this can be done either in the office or operating room). This can help patients avoid surgery, put the final result in terms of appearance and nasal breathing can be wanting. Once the bones have begun to heal surgery to re-fracture and reposition the nasal bones and cartilage is needed. The best treatment plan is one that takes into account the manner and pattern of injury along with the patient’s expectations. When these are all appropriately managed, good results usually follow.

Joshua Rosenberg, MD

Assistant Professor of the Division of Facial Plastic and Reconstructive Surgery