Injuries to the nose and face are common for both weekend warriors and children involved in sports. The bleeding and possible disfigurement associated with facial trauma can cause great anxiety for patients or the parents of injured children. Joshua Rosenberg, MD, Co-Chief of the Division of Facial Plastic and Reconstructive Surgery at Mount Sinai’s Department of Otolaryngology – Head and Neck Surgery, explains what happens during a nasal fracture and what you should do immediately following the injury.
How common are nasal injuries and fractures?
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 two to three times more common in males, most often occurring in patients between ages 15 and 40. The most common causes are accidents, physical altercations, and sports. Within sports, soccer accounts for the highest percentage, at 40 percent of all sports-related nasal injures. In younger children, sports-related injuries are the leading cause of broken noses, accounting for 65 percent of all nasal fractures.
What happens during a nasal fracture?
The nose is composed of paired nasal bones at the top and paired cartilaginous elements at the bottom. The nasal septum, which divides the nostrils, is also made up of both bone and cartilage. Nasal fractures typically involve injury to both the bony and cartilaginous elements. A deviated septum may also result from the injury.
At the time of the fracture, bleeding often occurs and can be impressive. It can usually be stopped by holding pressure (pinching the nose) or by nasal packing applied by a trained medical professional. Swelling of the nose soon follows, along with bruising, especially underneath the eyes.
How do I know if my nose is fractured?
A broken nose can be diagnosed during a clinical exam. However, most patients complaining of the injury are keenly aware of their broken nose symptoms, which include swelling, bruising around the nose and eyes, a change in the appearance of the nose, and increased difficulties with nasal breathing.
X-rays can be performed, but because the nose is primarily composed of cartilage, they often do not 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 difficulty in breathing that frequently results can be especially bothersome and will often drive them to seek medical attention from an ear, nose, and throat surgeon.
How are nasal fractures treated?
Patients have several treatment options to correct the form and function of their fractured nose. In the early period after an injury, the bones can sometimes be manually pushed back into place, either in the doctor’s office or the operating room. While this option can help patients avoid surgery, the nose’s appearance as well as the patient’s nasal breathing may not return to normal.
Once the bones have begun to heal, a rhinoplasty can be performed to restore the pre-fracture appearance and full nasal breathing. During this procedure, surgeons will re-fracture and reposition the nasal bones and cartilage. Surgeons can also correct a deviated septum which may have resulted from the injury (called ‘septorhinoplasty,’ as it involves the nasal septum).
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, is an Assistant Professor, Otolaryngology at the Icahn School of Medicine at Mount Sinai. A diplomate of the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, Dr. Rosenberg is an expert in facial plastic and reconstructive surgery and microvascular reconstruction.
