Nasal fracture - aftercare

If your nose is crooked from the injury you may need a reduction in order to put the bones back in place. If the break is easy to fix, a reduction can be done in the health care provider's office. If the break is more severe, you may need surgery to fix it.

You may have a hard time breathing through your nose because the bones may be out of place or there is a lot of swelling.

You may have one or all of these symptoms of a broken nose:

• Swelling on the outside and on the bridge of your nose
• Pain
• A crooked shape to your nose
• Bleeding from either inside or outside the nose
• Difficulty breathing through your nose
• Bruising around one or both eyes

Your provider may need to get an x-ray of your nose to see if you have a fracture. A CT scan or other tests may be needed to rule out a more serious injury.

If you have a nosebleed that does not stop, the provider may insert a soft gauze pad or other kind of packing into the bleeding nostril.

You may have had a nasal septal hematoma. This is a collection of blood within the septum of the nose. The septum is the part of the nose between the 2 nostrils. An injury disrupts the blood vessels so that fluid and blood may collect under the lining. Your provider may have made a small cut or used a needle to drain the blood.

If you need surgery, you will need to wait until most or all of the swelling has gone down. In most cases, this is 3 to 6 days after your injury. You may be referred to a special doctor -- such as a plastic surgeon or an ear, nose, and throat doctor -- if the injury is more severe.

For simple breaks, in which the nasal bone is not crooked, the provider may tell you to take pain medicine and nasal decongestants, and to put ice on the injury.

To keep pain and swelling down:

• Rest. Try to keep away from any activity where you could bump your nose.
• Ice your nose for 20 minutes, every 1 to 2 hours while awake. DO NOT apply ice directly to the skin.
• Take pain medicine if necessary.
• Keep your head elevated to help reduce swelling and improve breathing.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• DO NOT take more than the amount recommended on the bottle or by your provider.

You can keep doing most daily activities, but use extra care. It may be difficult to exercise strenuously because breathing through your nose may be impaired by swelling. Try not to lift anything heavy unless your provider says it is OK. If you have a cast or splint, wear this until your provider says it is OK to take it off.

You may have to avoid sports for a while. When your provider tells you it is safe to play again, make sure to wear face and nose guards.

DO NOT remove any packing or splints unless your doctor tells you to.

Take hot showers to breathe in the steam. This will help ease stuffiness and break up mucus or dried blood that builds up after surgery.

You may also need to clean the inside of your nose to get rid of dried blood or drainage. Use a cotton swab dipped in warm soapy water and carefully wipe the inside of each nostril.

If you take any medicines nasally, talk to your provider before using them.

Follow up with your doctor 1 to 2 weeks after your injury. Based on your injury, your doctor may want to see you more than one time.

Call the provider if you have:

• Sudden numbness or tingling
• Sudden increase in pain or swelling
• Any open wound or bleeding
• Injury does not seem to be healing as expected
• Difficulty breathing that does not go away
• Any changes in vision or double vision
• Worsening headache
• Nausea and vomiting
• Fever
• Foul smelling and/or discolored (yellow, green, or red) drainage from the nose

Chegar BE, Tatum SA. Nasal fracture. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 33.

Mayersak RJ. Facial trauma. In: Walls RM, Hochberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 35.

Reddy LV, Harding SC. Nasal fractures. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery, vol 2. 3rd ed. St Louis, MO: Elsevier; 2018:chap 8.