The nasal bones are the most delicate bones of the external facial skeleton. They project from the maxilla and frontal bones and provide the stable foundation for the anteriorly projected nasal cartilaginous skeleton.Fractures of the nose can not only result in cosmetic changes, but also lead to functional concerns like chronic nose bleeds, a deviated septum, nasal obstruction, septal perforation, nasal valve collapse, and recurrent sinus infections. In fact, it is quite common to have permanent obstruction of the nasal passages after sustaining nasal trauma. Cosmetic changes include and hump on the nasal dorsum, projecting bony spurs, a twisted nose, and possible changes to the texture of the skin.
Anatomy
What is the nose made of?
The upper third of the nose is compromised of bone and the lower two-thirds of cartilage. The nasal septum is a midline structure made up of cartilage anteriorly and wafer thin bone posteriorly that provides support to the lower two-thirds of the nose. The septum extends posteriorly dividing the nose into the right and left nasal passages effectively segregating airflow between left and right sides on the nose. The septum is integral in normal respiration and humidification of inspired air.
What happens when the nose is broken?
Typically, a nasal fractures are associated with fracture of the nasal bones resulting in cosmetic and functional changes to the nose. Nasal fractures do not only effect the nasal bones and may cause injury to the nasal cartilage and septum as well. Both nasal bone and nasal cartilage injury may occur after a nasal “fracture”. Separation or tearing of the nasal cartilages and fracture and deviation of the nasal septum can also cause significant nasal dysfunction (deviated septum, septal hematoma, septal perforation) as well as cosmetic deformity. Nasal turbinates can also permanently swell and retain their enlarged size well after the initial trauma has healed, causing nasal obstruction.
Diagnosis
How do I know if I broke my nose?
A nasal fracture is typically readily apparent to the patient. Besides the pain associated with the trauma, you may also experience an acute severe nosebleed and hear an audible “ crack”. This is usually followed by swelling of the nose, black and blue bruises around the eyes, and difficulty breathing through the nose. These telltale signs of a nasal fracture.
Nasal deformity
Acute nosebleed
Nasal obstruction
Nasal swelling and bruising
Swelling within the first several days after injury may obscure the appearance of a crooked nose. A crooked nose appears days or weeks later once swelling has subsided.
When should I see a doctor?
Prompt evaluation is mandatory for all cases of suspected nasal fractures. In addition to management of acute nose bleeds, it is important to seek medical evaluation in order to rule out potentially dangerous complications such as a septal hematomas. A septal hematoma is a potentially dangerous complication after nasal trauma where blood accumulates between the septal cartilage and the lining of the septum causing necroses of the underlying cartilage. Untreated septal hematomas may lead to nasal collapse, chronic nasal obstruction, infection and septal perforation.
Dr. Hamilton will drain blood from a septal hematoma to prevent infection or perforation of the nasal septum.
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