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Fracture of Nasal bone – Closed reduction

Nose is the most protruding part of ones body, hence gets injured so often and so easily.

Fractures of the nasal bones are common injuries that result from direct trauma to the nose. Because of its location, its lack of support, the nose is commonly fractured in motor vehicle accidents, falls, and contact sports.

The nasal septal cartilage may be fractured along with the nasal bones, making reduction more challenging. Other facial fractures often associated with nasal fractures include fractures of the midface (ethmoid, lacrimal, and frontal bones, also called LeFort fractures), orbital wall, cribriform plate, maxilla, and frontal sinus.

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Common symptoms of broken nose include pain and swelling across the bridge of the nose and into the cheeks, difficulty in breathing through the nose, and nosebleed (epistaxis). Later it can lead to black eye. Signs of trauma include obvious deformity of the nose, bleeding from the nose facial swelling, cuts and bruising –ecchymosis, around the nose and eyes.

Palpation of the nose may reveal tenderness, and crepitation. Anterior rhinoscopy should be performed; the presence of clear fluid suggests the possibility of leaking cerebrospinal fluid. The nasal septum is examined for a mass of blood in the tissues (septal hematoma).

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X-ray of facial bones or CT scan will be helpful in planning treatment and to find out other injuries.

Because the nose has many small blood vessels, individuals who sustain trauma to the nose and face may bleed profusely. Bleeding can be controlled by gentle suction cleaning and removal of clots, application of a topical vasoconstrictor, merocel gauze packing, and inserting Foley’s balloon.

Severe edema of the nose and surrounding tissues can be reduced by application of ice or cold packs. The individual may receive medications, including analgesics to control pain, antibiotics and decongestants to reduce nasal swelling.

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Simple fractures may not require any treatment, provided that the individual is satisfied with the cosmetic appearance. For most fractures, individuals are treated with closed reduction of the fracture under either topical or local anesthesia after the swelling has subsided 5-7 days after injury). If a septal hematoma is present, surgical evacuation is performed to prevent chronic nasal deformity.

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Open reduction under general anesthesia may be required if there is extensive fracture and dislocation of the nasal bones and septum. Untreated cases of nasal fracture often require septorhinoplasty. Postoperative splinting of the nose, either external or internal, is often used for 7 to 10 days after either closed or open reduction.

Prognosis, is excellent in non displaced nasal fractures, they usually heal well with no cosmetic or functional deformity. Displaced fractures, even after closed reduction, often have residual cosmetic deformity and septal deviation, at times necessitating septorhinoplasty.