Nasal injury & Fracture

The nose is made up of bone and cartilage, and has an external skin covering and an internal mucosal lining. Trauma to the nose can cause damage to any of the above structures. Depending on the nature of trauma, nearby structures to the nose (inparticular cheek bones, the eyes, or more rarely the brain and its surrounding lining) may also be injured.

How do I know if my nasal bones are fractured?

Following injury the soft tissue of the nose becomes swollen, this makes it difficult to diagnose a fracture at this early stage. The swelling usually subsides after 5 days and it is then possible to ascertain if there is any change to the shape of the nose as a result of the trauma. An X-ray of the nose is of little value, and does not contribute towards the management

You should be assessed by the medical team at your General Practitioner’s surgery or at the Accident & Emergency department. They will ensure that there are no other associated injuries to nearby structures, and exclude a “septal haematoma”. (see below). They may, if necessary, arrange for you to be reviewed by an ear,nose and throat specialist seven to ten days after your injury.

Septal haematoma: develops when blood collects (haematoma) under the nasal lining of the septum (the central partition wall of the nose). This causes the septal lining to protrude into the nasal cavity and causes a blockage of the nostril. This haematoma needs to be drained surgically. If left untreated it may become infected or cause destruction of the cartilage of the septum. This in turn will give rise to a marked deformity of the nose, often termed a “saddle deformity”

What is the treatment for fractured nasal bones?

Any trauma to the skin will need to be managed appropriately, by cleaning the wound and closing it with the appropriate material. An injection may be necessary to prevent tetanus if your vaccination is not up to date.

When you are reviewed by the ear, nose and throat surgeon, and the presence of the fracture is confirmed the options are:

a.to leave things be and live with the deformity or

b.to have manipulation of the fracture under anaesthetic.

Manipulation of fractured nose 

This is a daycase procedure. It is often done under a short general anaesthetic. This needs to be undertaken preferably within 14 days of injury. After this time the fracture healing process is almost complete and thus it becomes difficult to manipulate the bones. The objective of this procedure is to improve the appearance of the nose. The patient however needs to be aware that this cannot be guaranteed. If there is any residual deformity, a more formal operation may be necessary 12 months or more after the injury to improve the appearance.