Broken Noses

My son received an injury to his nose while jumping on his trampoline. It bled a little at first, but about two hours later, it was swollen to almost twice its size and was completely blue. We were told my our doctor that it could not be x-rayed for several days until the swelling goes down.

What is your opinion about nose injuries. Can a broken nose be corrected or does it heal itself? Is there any potential blockages that could occur or any other concerns that we should know about?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

It's hard for active children to avoid getting their noses hit every once in a while. In fact, trauma to the nose accounts for the majority of injuries to the face in children. Most of the time, these misadventures lead to nothing more than a brief bit of pain and possibly a bruised ego. However, certain nasal injuries can cause significant damage and need to be examined by a doctor immediately.

Bruising and swelling of the skin overlying the nose is the most common symptom after a nasal injury. But tissues within the nose vital to its structure can have damage as well. The septum or tissue separating the nasal passages is made up of cartilage which can be broken when hit. In addition, the upper part of the nose is made of bone which can also break. Most of the time, it is obvious that the nose is broken because it becomes deformed. However, the tissues in this area can swell very quickly after being hit. And sometimes this swelling hides the signs of the fracture.

But probably the most concerning problem with a nose that has had significant injury is the presence of a septal hematoma. A hematoma is a pocket of blood trapped within tissue. When this pocket of blood occurs within the tissues that separate the two sides of the nose, it is called a septal hematoma. When blood accumulates within this cartilage, the pressure can choke off the blood supply to the septum. Then the tissue dies causing the nose to "cave-in" creating what is called a saddle-nose deformity; so named because the nose makes the shape of a saddle. The only way to keep this from occurring is to have the nose immediately examined and the blood pocket surgically drained.

Broken noses which are in alignment (or straight) will generally heal straight although a splint is usually applied to assure this will occur. Many times, as I said, determination of the whether a break is actually present is difficult because of all the swelling. Therefore, it is quite common to allow 3-4 days to go by to allow for swelling to subside. Then, if a break is detected, a splint may be applied. Waiting those few days does not cause any problems. However, if more than seven days goes by before re-evaluation and a significant break is present, the fragments of the break will begin to form strong bonds which will make fixing the break much more difficult. Presumably, your son was cleared of having a septal hematoma when he was first examined. Therefore, the most important thing for you to do is make sure he is re-evaluated within 3-4 days.

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