Nasal Fracture

What happens to the nose in a nasal injury?

Most cases result from sports injuries, fall or assaults. Patients are usually referred to ENT from the Emergency Department. There may be associated injuries to the facial bones or elsewhere which will have been assessed in the Emergency Department already.

The nose becomes very swollen and bruised, and there may be bleeding from the nose soon after the injury, followed by blockage. The nose will be painful to touch and there may be numbness of the tip of the nose, upper lip or upper middle gum.

X-rays of the nose are not routinely taken of needed (unless there are other facial injuries which need to be assessed).

Bruising around the eyes fades over a week or so, and most of the nasal swelling settles within a few days.

Timing of surgery

We like to see patients about 5 to 7 days after the injury. This gives time for the swelling to settle down and makes it easier to see if the nasal bones have been broken and are out of line. If straightening of the nose is to be done, this needs to be within a couple of weeks of the injury otherwise the nasal bones will begin to knit together.

What does the operation involve?

The operation would usually be done as a day case. It is performed under a general anaesthetic and just takes a few minutes. Once you are asleep your nasal bones will be manipulated to put them back into the right place. There are no cuts made in the skin and we would expect very  little  extra bruising or swelling from the operation. If the fracture is stable, there will be no dressings. If the fracture is unstable, the nasal bones may be protected with a plastic moulded splint which is taped across the forehead and across the nose and should be kept on for a week.

Very occasionally there is some bleeding from the nose at the time of the operation and a pack in the nostril may be required to deal with this. The dressing would usually be taken out after a few hours.

Your nose may feel a little uncomfortable or sore. Simple painkillers should help with this.

POST OPERATIVE CARE

You should not drive or operate heavy machinery for at least 24 hours after a general anaesthetic.

Once the plastic splint is removed the nasal bones will still not be as strong as before the injury and so you should be careful to avoid any contact sport or any other activity which is likely to risk a repeat injury to your nose for at least 3 weeks after the operation.

We would not normally arrange for any further review appointments but some patients have a nasal septum injury noted at the time of the procedure and may be reviewed back in the clinic to decide whether surgery to straighten the nasal septum should be planned for a later date.

Where can I find out more about the operation?

ENT UK have a  website with information on many ENT conditions and they have a section covering nasal injuries:

https://entuk.org/ent_patients/nose_conditions/injuries

You could simply Google ‘nasal fracture information leaflets’.

(I would like to thank Mr G R Ford  from Dorchester Hospital, England, for his help with the preparation of these leaflets)