How to distinguish a fracture from a bruise
When bruised, the nose hurts and swells, but its shape and patency are preserved. A fracture is indicated by visible curvature of the bridge of the nose, crunching or mobility of fragments, persistent congestion on one side, and profuse bleeding immediately after the blow. Bruises under both eyes do not necessarily mean a fracture: the blood simply descends into the loose tissue of the eyelids. It is difficult to reliably distinguish one from the other through edema, so the final word lies with a doctor’s examination and an image.
- Noticeable shift of the nasal bridge to the side or down
- Crepitation - a crunching sound when gently palpated
- Nosebleed immediately after impact
- Persistent difficulty breathing with one half of the nose
- Pain when trying to touch the bridge of the nose
What to do in the first hours
Sit down and tilt your head slightly forward to prevent blood from flowing into your throat; no need to tilt your head back. Pinch the wings of your nose with your fingers for 10–15 minutes and apply cold through the cloth for 15 minutes intermittently. Do not straighten your nose yourself or try to “put it back in place” with your hands: this can easily increase the displacement and injure the mucous membrane. During the first 24 hours, avoid hot showers, baths, physical activity, and blowing your nose to prevent bleeding from resuming.
- Cold through a cloth for 15 minutes on the first day
- Finger pressing of the wings of the nose during bleeding
- Painkillers as prescribed by your doctor
- Don't blow your nose or sleep face down
- Contact an ENT doctor within 1–3 days
Diagnostics
The doctor examines the external nose, assesses symmetry, palpates the back and always examines the nasal cavity from the inside: this is how a deviated septum, mucosal ruptures and septal hematoma are detected. X-rays of the nasal bones confirm the fracture and help assess displacement. If a fracture of the walls of the orbit, zygomatic bone or base of the skull is suspected, as well as in case of associated trauma, computed tomography is prescribed. It is useful to bring a photograph of the face before the injury - it helps to understand what the original shape of the nose was.
- External examination and palpation
- Anterior rhinoscopy and endoscopy of the nasal cavity
- X-ray of the nasal bones in lateral projection
- CT scan for suspected orbital or skull base fracture
- Eye examination for double vision and eyelid injury
Reposition and surgery
If there is displacement, the fragments are returned to their place - this is a closed reduction. It is performed under local anesthesia or short anesthesia and they try to carry it out in the first 7–10 days, while the bones are mobile: in children the period is even shorter. After realignment, the nose is fixed with tampons and an external bandage or splint. If more than two to three weeks have passed since the injury, the bones have time to heal, and the shape and breathing can be corrected only with a planned operation - septoplasty or rhinoseptoplasty in a few months.
- Closed reduction in the first 7–10 days
- Local or general anesthesia according to indications
- Nasal packing and fixation bandage
- Mandatory opening of septal hematoma
- Delayed septoplasty for old deformity
Recovery and complications
The swelling noticeably subsides within 7–10 days, and the final shape of the nose becomes clear after 2–3 months. During this period, contact sports, saunas, active bending, and wearing heavy glasses on the bridge of the nose are not recommended. The most common late problems are persistent deviated septum with difficulty breathing and cosmetic deformation. A separate danger is a septal hematoma: accumulated blood compresses the cartilage, it can fester and collapse, and the nose can settle. Therefore, an inspection from the inside is as important as a photograph.
- Complete abstinence from contact sports for 4–6 weeks
- Avoid baths, saunas and hot showers for 2 weeks
- Do not wear heavy glasses until healing
- Follow-up examination by an ENT doctor in 5–7 days
- Contact again if congestion and pain increases
