It’s Spring and I’m starting to see more and more nasal fractures. People are outside enjoying the weather and playing sports. Unfortunately, accidents happen- inadvertent elbows, mis-played line drives, and simple clumsiness can all result in a broken nose. Here are my tips about what to do next.
A broken nose is rarely subtle- you’ll immediately experience pain, bleeding, and swelling. The first thing to do is make the bleeding stop!
To make a nose stop bleeding, do the following things:
1) Hold pressure as best you can – this means pinching your nose from the outside as hard as you can tolerate. It is going to hurt, but pressure will help to slow down the bleeding.
2) Ice! Apply ice to the bridge of your nose. The cold will slow down the blood going through your nose and decrease bleeding. It will also help the pain and limit swelling.
3) If those things don’t make the bleeding stop, spray some over-the-counter decongestant spray like Afrin® (oxymetazoline) into both nostrils. Afrin® makes your blood vessels clamp down which helps bleeding stop.
Once the bleeding stops, take something for the pain! Anti-inflammatory medicines like Advil® (ibuprofen) and Aleve® (naproxen) are best for fracture pain. That night, try to sleep with your head elevated to limit swelling and help prevent further bleeding.
A patient with a freshly broken nose- no black eyes yet, but very swollen!
Even if you follow these steps to the letter, your nose is still going to get swollen. You may also develop black eyes in the first couple of days following your injury. Nasal saline spray is helpful to clear out your nasal passages and is safe to use if you have a freshly broken nose. You can get it in the cough and cold section of any grocery store or pharmacy.
If you got knocked out, or if you develop a headache or blurry vision, you should go to the emergency room. However, If the bleeding stops and you don’t have any other injuries, you generally don’t need to go to the ER for a broken nose. X-rays are rarely helpful.
I’ll need to see you a few days following your injury. We will talk about your breathing and how your nose looks. If you’re still puffy and your nose isn’t obviously pushed to one side or the other, we’ll probably need to see you again once the swelling goes away. However, if your nose is obviously crooked or your septum is affecting your breathing, I will recommend that we fix it.
If the nasal bones are fractured, but your septum is ok, we can often repair your nose in the office! I use a lot of numbing medicine and may have you take a pain pill before you come. Once you’re good and numb, I push the nasal bones back into their normal position.
We use this instrument. It’s called a Nose Shimmy. Just kidding, it’s called a Goldman elevator (named for Dr. Goldman who was a rhinoplasty surgeon). It goes in your nose. Don’t worry, you’re nose is numb and happy before this comes anywhere near you!
Once the nasal bones have been straightened, we put this cast on the outside of your nose using special adhesive and tape. It’s super cute and can be autographed! It has to stay on for about a week to protect the bones as they heal.
Here’s a video of how it’s done:
If you’d prefer, I can also perform the repair at the hospital under general anesthesia so you aren’t aware of what is going on. It will be more expensive and the logistics become more complicated, but it’s a perfectly viable option for patients with strong preferences. We have a two week window after the injury before the bones have healed too much to be easily moved. If the bones heal in a crooked way, we can still fix it, but you need a nose job!
Unfortunately, if you have a severely deviated septum as a result of your injury, you will need surgery to help you breathe better. For more information, check out this post on deviated septums!