How to handle nasal fractures

Nasal fracture is a common type of injury. But sometimes it can be dangerous causing serious complications.

A broken nose is any crack or fracture in the bony portion of the nose. This is usually a result of external trauma. Blows to the face during altercations, vehicle accidents, falls and sports injury are the most common reasons for a fractured nose. Nasal fractures are often cited as the most common type of facial fracture, accounting for approximately half of all facial fractures in several studies.
It is usually caused by blows to the front or side of the nose by penetrating wounds. Causes of a broken nose are related to trauma to the nose or face.
It is usually obvious that there is an injury to the nose due to bruising, swelling, and bleeding from the nose. A history of traumatic injury should lead to suspicion of a broken bone in the nose or nasal fracture.
Signs that suggest a person has a broken nose may include the following:
• Tenderness when touching the nose
• Swelling of the nose or face
• Bruised nose
• Bruising under the eyes (black eye)
• Deformity of the nose (crooked nose)
• Depression or lateral displacement
• Nosebleed
• When touching the nose, a crunching or crackling sound or creaking sensation like that of rubbing hair between 2 fingers
• Pain and difficulty breathing out of the nostrils
• Nasal obstruction
It is advised to seek medical care in the following situations:
• The pain or swelling does not go away in 3 days
• The nose looks crooked
• Breathing through the nose is not possible after the swelling has gone down
• A fever develops
• Recurring nosebleeds develop
• A significant injury that requires medical attention possibly exists
Go to a hospital's emergency department immediately if the following signs or symptoms are present:
• Bleeding for more than a few minutes from one or both of the nostrils
• Bleeding from the nose does not stop
• Clear fluid draining from the nose
• Other injuries to the face or the body
• Open laceration to the nose or the face
• Loss of consciousness (fainting)
• Severe or unrelenting headaches
• Repeated vomiting
• Decrease or change in vision
• Neck pain
• Numbness, tingling, or weakness in the arms
• Significant injury that may require immediate medical attention
Taking the following actions at home may help reduce the symptoms of a broken nose.
• Place ice wrapped in a cloth over the nose for about 15 minutes at a time and then remove the ice
• Take acetaminophen, paracetamol or ibuprofen to reduce pain
• Elevate the head, especially when sleeping, to avoid increased swelling of the nose. Prop the head up with pillows
1. Early: If the patient is seen very early, before swelling appears, reduce immediately. Local analgesia is often sufficient.
2. Intermediate: When the swelling is marked and the landmarks lost, leave until the swelling has subsided.
3. Late (7-14 days): Probably the most satisfactory time to treat is as soon as the swelling has subsided.
When the swelling has subsided reduction can be undertaken under local or general anaesthesia.
4. Malunion: Requires rhinoplasty.
Best clinical practice includes:
• Avoid drug and alcohol use. Many nose breaks occur during or after abuse of these drugs
• Follow safety rules when participating in sports and physical recreation
• Wear a seatbelt and helmet at all times while riding in a motor vehicle or motor cycle
• Make sure children are in an approved car seat when riding in a vehicle

The Write up is compiled by Prof Kamrul Hassan Tarafder, Dpt of Otolaryngology, Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU).