What is a nasal fracture?

Any crack in the bone or cartilage of your child’s nose is considered a fractured, or broken, nose. The bone is the bridge of the nose, and the cartilage includes the septum, or wall inside the nose that divides the nostrils. Because the nose sticks out, it’s vulnerable to fracture when your child falls or plays sports, for instance. Roughly half of all facial fractures are broken noses. 

In most cases a broken nose causes a bent, or crooked, nose and changes in breathing.  If the doctor doesn’t reposition the bones within two weeks, your child’s nose will heal crooked and need a formal reconstruction to correct it.

You can’t always tell if your child’s nose is broken just by looking at it. Swelling can obscure whether it’s bent or not. That is why it is best to evaluate the nose five to seven days after the injury when swelling has decreased. But a nose can also be broken but not bent, if the break was minor.

A broken nose can also cause more serious problems, such as a septal hematoma, which is a blood clot that forms within the wall inside the nose. If not drained, this clot could lead to a serious infection. Other complications include a hole in the nasal septum (septal perforation) that can cause the bridge to collapse.

To reduce the risk of complications, a suspected nasal fracture should always be checked out by your primary care provider right away, regardless of how much swelling, bleeding or pain it causes. 

Cause

A sudden impact to your child’s nose or face is the most common cause of a fracture. The typical ways this happens in childhood include:

• An accident, like falling off a bike or walking into a wall
• Contact sports, like basketball and hockey
• Car accidents

Signs and symptoms

A child’s symptoms can vary depending on the degree of the break. A broken nose generally causes any of these symptoms:

• Pain
• Nosebleeds
• Blocked nasal passages and difficulty breathing
• Swelling of the face
• Bruises around the eyes — a look of “black eyes”
• A crooked nose
• Tenderness when touching the nose
• A grating or crunching sound when touching the nose

Take your child to the ER right away if he has any of these symptoms, which could signal additional, more serious problems like a concussion or spinal injury:

• Bleeding from the nose that doesn’t stop
• Clear fluid draining from the nose
• Loss of consciousness
• Severe headaches
• Repeated vomiting
• Change in vision
• Neck pain
• Numbness or weakness in the arms

Testing and diagnosis

Your primary care provider may examine your child but will likely refer him to a specialist.  While a primary care provider can evaluate a broken nose and offer pain and infection management, he or she may not be trained in repositioning the bones or managing complications. An otolaryngologist (ear, nose and throat specialist), is generally recommended to diagnose, manage and fix a broken nose. To diagnose a broken nose and assess the extent of damage, he or she may:

• Conduct a physical exam, including a thorough inspection of the face, head and neck.
• Take a medical history, especially details surrounding the injury and the appearance of your child’s nose prior to the injury.
• Use a lighted instrument, called a nasal speculum, to inspect the nostrils and the nasal septum and to check for blockages and complications, like a septal hematoma.
• Obtain an X-ray or CT scan to determine whether there are other facial or jaw fractures. These scans generally aren’t used to confirm a broken nose.