Broken nose
The nose breaks more often than any other bone in the face: it sticks out, and the bones in it are thin.
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Medicines commonly prescribed for Broken nose
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 325 mg acetaminophenActive substance: paracetamolManufacturer: Ferrer Internacional S.A.Prescription not requiredDosage form: EFFERVSCENT ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Viatris Healthcare LimitedPrescription requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Zentiva K.S.Prescription required
The nose breaks more often than any other bone in the face: it sticks out, and the bones in it are thin. In most cases the whole thing amounts to a bruise, some swelling and a couple of awkward weeks, after which the shape comes back on its own. But this apparently harmless injury has two turns that make it worth taking seriously: blood collecting inside the septum, which has to be let out within days, and signs that the blow damaged more than the nose. Both are covered below, and it is better to read them before the swelling goes down.
How to tell the nose is broken
Straight after a blow the nose swells and hurts and often bleeds — all of that happens without a fracture too. What points to a break:
- a crunch, or a feeling of movement, when you touch the bridge;
- a visibly changed shape, with the nose pushed to one side or the bridge flattened;
- a nose that has stopped breathing on one or both sides and does not clear once the swelling settles;
- bruising under both eyes appearing a day later.
The main difficulty is that for the first two or three days the nose is swollen and neither you nor the doctor can judge its shape. So there is no point rushing to conclusions: the assessment is usually made between day three and day seven, once the swelling drops. Finding a photograph of yourself from before the injury helps the doctor far more than you would expect.
And one more thing that often surprises people: an X-ray of the nasal bones is usually unnecessary. Those thin bones show up poorly, and the image does not change the decision, which rests on how the nose looks and how it breathes. A scan is reserved for a suspected fracture of the other facial bones or a head injury.
What to do in the first days
If the nose breathes, the shape has not changed and there are no warning signs, treatment happens at home.
- Apply something cold wrapped in cloth for ten to fifteen minutes several times a day during the first forty-eight hours. Ice does not go straight onto the skin, and the nose is not pressed.
- For bleeding, sit down, tip your head forward and pinch the soft part of the nose just above the nostrils for fifteen minutes without letting go to check. Do not tilt your head back — the blood runs into the throat.
- Ordinary over-the-counter painkillers are fine for the pain; ask a doctor or pharmacist which one suits you, especially if you already take other medication.
- Sleep propped up on extra pillows, as the swelling clears faster that way.
- Do not blow your nose or pick at it for at least a week: that is how infection gets in.
- Leave glasses off while the swelling lasts, if you can manage without them.
- Postpone hard physical effort for a couple of weeks, and any sport where you might take a knock to the face for about six.
Septal haematoma, the thing not to miss
The septum divides the two sides of the nose and is fed by the thin lining that covers it. A blow lets blood collect between the two, the lining peels away, and the cartilage is left without a blood supply. The cartilage then dies, and a few weeks later the bridge of the nose collapses — a deformity that afterwards needs major surgery to correct.
Suspecting it is easy once you know where to look. Look inside the nose in good light: with a haematoma there is a soft purple or bluish bulge narrowing or completely blocking the passage, usually on both sides. The nose does not breathe at all, there is a sense of pressure, the pain increases rather than easing, and sometimes a fever appears, which means the blood has become infected.
This is not something to watch at home. The blood has to be drained within days, the sooner the better; it is a straightforward procedure done under local anaesthetic. Check children particularly carefully: they complain little, their cartilage breaks down faster, and the growth of the whole nose suffers afterwards.
When to go to the emergency department
Do not delay if any of the following appears after a blow to the face:
- bleeding that does not stop after twenty minutes of pressure, or blood running heavily down the back of the throat;
- clear watery fluid trickling from the nose, especially when you lean forward, with a slightly salty taste — that is fluid escaping from inside the skull;
- double vision, an eye that moves less well or looks sunken, loss of vision;
- numbness of the cheek, the side of the nose or the upper lip;
- teeth that no longer meet as they did, or difficulty opening the mouth;
- severe headache, vomiting, confusion, loss of consciousness even briefly, seizures;
- neck pain or stiffness, tingling or numbness in the arms;
- a deep wound with glass or dirt left inside it.
If any of this applies, do not drive: ask someone to take you or call an ambulance — across Europe the emergency number is 112. Take a list of your medicines with you; the doctor must know about blood thinners in particular.
What the doctor can do
A crooked nose is not straightened immediately, and not in every case. The doctor examines it outside and in, checks the breathing and decides whether a reduction is worthwhile — the manoeuvre in which the bones are pushed back into place through the nose, with no cuts.
What matters here:
- reduction has a window: in adults it is done roughly within the first two weeks after the injury, in children sooner. Later the bones set in their new position and can no longer be moved;
- it is carried out under local or general anaesthetic, depending on the injury, the age and the practice of the clinic;
- the result is good but not guaranteed: the nose usually ends up noticeably straighter, though not always exactly as it was;
- if the window has passed, or the shape and the breathing have not come back, what remains is planned surgery on the nose and septum, and that is not done until several months later, once everything has fully healed.
Cuts on the nose are stitched or closed with adhesive strips, and if they are dirty the tetanus vaccination is checked.
How it usually ends
For most people, with nothing at all: the swelling goes in one to two weeks, the bruising in two to three, the bone knits in about six, and the nose looks as it did. Of what stays behind in a minority, the ones worth naming are blockage from a deviated septum, an altered shape of the bridge, nosebleeds that keep returning, and a dulled sense of smell.
All of these can be dealt with, but they share one feature: the later someone comes, the bigger the procedure needed. The "I will wait and see if it straightens out" approach turns a ten-minute manoeuvre into an operation with a recovery period within a month. If two or three weeks after the injury the nose does not look the way it used to, or does not breathe, that is already the moment to see a doctor rather than to keep waiting.
Online consultation
Remotely it is easy to settle the main question of the first days: whether this is an ordinary injury that can be seen through at home, or whether a face-to-face examination is needed and how urgently. The doctor will go through how exactly you were hit, what can be seen inside the nose and how it breathes, explain which signs to watch for and what deadline matters if reduction comes into play. It is also a convenient way to discuss the blocked nose still there a month after the injury. The emergency signs listed above are not handled by video — with those you go straight to the emergency department.
This material is for information only and does not replace medical advice.
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