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June 10, 2009

What To Do With a Broken Nose?

The only reason to see a physician immediately after an injury to the nose is to assess whether a septal hematoma has formed. The septum is a wall that divides the right nasal cavity from the left. If a hematoma has developed (which is VERY rare), it needs to be drained in an approach similar to doing a deviated septum repair.

Regarding the "broken" nose itself...

I personally think getting an X-ray to look for an isolated broken nose is a waste of time and money. Perhaps the ONLY time I would think about getting it is for legal reasons (the victim plans to sue the assailant if applicable).

However, my standard spiel is one only does something about a nasal fracture (surgically) if there is a problem with

1) Function (ie, can't breath through the nose due to fracture and not because of mucosal swelling)

OR

2) Form (cosmetically unacceptable to the patient once soft tissue swelling goes down all the way)

Otherwise, you do nothing... even if it is clearly broken on X-ray (if one was obtained). If the answer is affirmative to the one or both of the above, than you fix it. Therefore, why bother with the X-ray if it doesn't change management?

In any case, the best thing to do if there is a concern for a broken nose is to ice it like crazy (20 min on, 20 min off in cycles throughout the day while awake), keep the head elevated (even when sleeping), and take motrin for any pain/discomfort.

These measures minimize and resolve any swelling as quickly as possible.

Make an appointment with a plastic surgeon or ENT within 3-5 days.

If there is concern for other facial fractures beyond a broken nose, go to the ER and make sure they get a CT of the maxillofacial (no contrast).



For the athlete with a broken nose who wants to keep active, recommend getting a nose guard like this:
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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