Broken nose

A broken nose (also called a fractured nose) is a common injury after a knock to your face.

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When to go to the emergency department

A knock to your head or face can cause serious injuries.

Call 111 and ask for an ambulance if you have clear fluid trickling from your nose — you may have a serious head injury.

You should go to the hospital emergency department as soon as possible if you have a severe headache, neck pain or a stiff neck. This is especially important if you have:

  • numb or tingling arms
  • blurred or double vision
  • other symptoms of a severe head injury, such as loss of consciousness or repeated vomiting.

Symptoms of a broken nose

Broken noses are usually:

  • swollen
  • red
  • sore.

You may also have bruising, a bleeding nose or feel a crunching when you move your nose. Your nose might look bent, or you might find it hard to breathe through your nose.

You should see a healthcare provider quickly if you have:

  • a nosebleed that will not stop
  • a cut or graze over your nose
  • a blood clot or swelling inside your nose between your nostrils — this may be a septal haematoma, which needs to be drained straight away.

Nosebleeds

Complications of a broken nose

Septal haematoma

Septal haematoma is when blood collects around the cartilage that separates the 2 sides of your nose.

It can cause pressure, which can lead to a hole in the cartilage separating the 2 sides.

This can then lead to congestion or even a collapse of the separating cartilage, which would then change the shape of your nose.

Infection

Infection can occur in a septal haematoma, leading to an abscess and making the damage to the cartilage worse.

If you have any open wounds on your broken nose, these can also get infected. This slows the healing and may lead to scarring.

If you are worried about either of these complications, talk to your usual healthcare provider.

Diagnosing a broken nose

A healthcare provider will usually be able to tell that your nose is broken from the way it looks.

You will probably not need an x-ray unless:

  • your healthcare provider thinks another bone in your face is broken
  • you have other injuries, like to your head or neck.

Treating a broken nose

Most broken noses can be managed at home.

  • To reduce swelling, gently apply an ice pack to your nose for up to 15 minutes, several times a day, for the first few days. Make sure there is a cloth between the ice and your skin to prevent damaging your skin.
  • Keep your head upright when lying in bed by adding more pillows. This will help to reduce swelling and throbbing.
  • Use a simple pain relief like paracetamol if needed.

Swelling usually goes down after a week, and bruising will go away in about 2 weeks.

You should see your healthcare provider if:

  • the pain gets worse, or does not get better with simple pain relief like paracetamol
  • the swelling has gone down, but you still find it hard to breathe through your nose
  • your nose looks crooked
  • the swelling has not gone down after a few days
  • you have nosebleeds that keep coming and going
  • you become hot and feverish with a temperature over 38 degrees Celsius.

If your nose is crooked or not the same shape as before, you may need to get it straightened (realigned) by an otolaryngologist.

It is best to do this within 2 weeks of the injury. You might need to wait until there is less swelling before your healthcare provider can decide if your nose needs to be straightened.

Caring for your broken nose

If you have your broken nose straightened, you will have a local anaesthetic, which numbs your nose for 2 to 4 hours.

It is best to have someone drive you home or wait 2 hours before you drive.

When you are home:

  • take 2 paracetamol tablets every 4 hours to control the pain — do not take any more than 8 tablets in one day
  • do not drink alcohol or take any recreational drugs for 24 hours, as these may react badly with the local anaesthetic
  • rest for the next 24 hours — do not try any heavy lifting or hard physical work for the next 2 days.

If the pain continues, or if you become hot and feverish with a nasty green nose discharge:

  • phone the hospital where you had your nose straightened
  • contact your usual healthcare provider.

Pain relief medicines for adults

Over the next few days you should:

  • be careful at times when you may bump your nose, such as when you have small children or animals on your knee, or when you are in bed at night
  • just dab your nose gently — do not wipe it vigorously or blow it hard
  • keep your mouth open if you sneeze
  • keep any plaster on your nose dry and stay out of the sun to avoid overheating (try to keep the dressing in place for at least a week)
  • if crusts form inside your nose, gently sniff warm, salty water from your cupped hand to soften them — do not pick your nose.

You should also avoid contact sport for the next 4 weeks as your nose heals.