Broken Nose: Symptoms, Types, Causes and Treatment

A broken nose, also called a nasal fracture, is one of the most frequent facial injuries worldwide. Whether it’s from a sports mishap, a fall, or an altercation, a fractured nose can be both distressing and disruptive. Understanding the symptoms, types, causes, and available treatments is key to both early recognition and optimal recovery. In this article, we’ll explore everything you need to know about broken noses, from spotting the warning signs to navigating treatment options.

Symptoms of Broken Nose

A broken nose can show up in many different ways, and recognizing the symptoms early is crucial for timely and effective treatment. Immediate symptoms are often obvious, but some may be subtle or develop over time. Let’s look at the most common signs that may indicate a nasal fracture.

Symptom	Description	Frequency/Importance	Source(s)
Pain	Discomfort or tenderness around the nose	Very common	1, 2, 4
Swelling	Puffiness of the nose and surrounding area	Very common	1, 2, 4
Bleeding	Nosebleeds (epistaxis)	Frequently present	1, 2
Deformity	Visible change in nose shape or alignment	Often present	4, 6, 7
Bruising	Discoloration around nose/eyes (“black eye”)	Common	2, 4
Nasal obstruction	Blocked or reduced airflow	Especially with septal injury	4, 6, 7
Hematoma	Blood collection inside the nose	Associated soft tissue injury	2, 6
Laceration	Cuts on or around the nose	In some cases	1, 2

Table 1: Key Symptoms of Broken Nose

Common Initial Symptoms

The most immediate signs of a broken nose are pain and swelling, typically developing within minutes of the injury. Patients often report tenderness when touching the nose or surrounding facial areas. Bleeding from the nostrils (epistaxis) is another frequent symptom, sometimes occurring right after the trauma or a bit later 1, 2.

Visible Deformity

One of the most telling signs is a visible change in the nose’s shape. This might be a noticeable bend, flattening, or deviation of the nasal bridge. Even a slight displacement can be obvious due to the nose's central and prominent facial location 4, 6.

• Tip: Sometimes, deformities are subtle—look for asymmetry or a “crooked” appearance.

Bruising and Soft Tissue Injuries

Bruising may appear around the nose or under the eyes (“black eyes”). Hematoma, or a blood collection inside the nose, is a common associated injury—especially in more severe or displaced fractures. Hematomas can cause pressure and should be promptly evaluated, as they may lead to complications 2, 6.

Breathing Difficulties

Nasal obstruction or difficulty breathing through the nose is particularly common if the nasal septum is involved. Obstruction may develop immediately or over several hours as swelling increases. Persistent blockage can signal a septal hematoma or significant internal displacement 4, 6, 7.

Cuts and Lacerations

In some cases, especially with more severe trauma, there may be external cuts or lacerations on or around the nose. These injuries can increase the risk of infection and may indicate a more complex fracture pattern 1, 2.

Types of Broken Nose

Not all nasal fractures are the same. The type of fracture can influence both the symptoms experienced and the approach to treatment. Nasal fractures are categorized by their displacement, whether the skin is broken, and if the nasal septum is involved.

Type	Description	Clinical Impact	Source(s)
Nondisplaced	Bones remain aligned	Mild symptoms, best outcomes	2, 7
Displaced	Bones are shifted out of normal position	Obvious deformity, obstruction	1, 2, 7
Closed	Skin is intact	Lower infection risk	2
Open	Skin is broken, bones exposed	Higher infection risk	2
Septal Fracture	Involvement of the nasal septum	Risk of obstruction, deformity	2, 4, 6, 7
Complex/Comminuted	Multiple bone fragments, may involve face	Severe symptoms, needs specialist care	1, 2

Table 2: Types of Nasal Fractures

Displacement: Nondisplaced vs Displaced

• Nondisplaced fractures: The most common type, where the nasal bones crack but remain in their normal position. Symptoms are usually milder, and external deformity may be minimal or absent 2.
• Displaced fractures: Here, the bones are shifted out of alignment, leading to a visible deformity and potentially significant nasal obstruction. Displaced fractures are more likely to be associated with soft tissue injuries and require more complex management 1, 2.

Closed vs Open Fractures

• Closed fractures: The skin over the nose remains intact. These make up the majority of nasal breakages and typically have a lower risk of infection 2.
• Open fractures: The overlying skin is cut or torn, exposing the bone. Open fractures require prompt medical attention to prevent infection and may be associated with more severe trauma 2.

Septal and Complex Fractures

• Septal fractures: Over half of all nasal fractures involve the nasal septum—the thin wall dividing the nostrils. Septal injuries can cause persistent nasal blockage, increase the risk of post-injury deformity, and require specific treatment (such as septoplasty) 2, 4, 6, 7.
• Complex or comminuted fractures: These involve multiple bone fragments and may extend into the cheeks, orbital bones, or other facial structures. They are more often seen in high-energy trauma (like traffic accidents) and need specialist intervention 1, 2.

Causes of Broken Nose

Understanding how and why broken noses occur helps in both prevention and diagnosis. The causes can vary by age, environment, and even social factors.

Cause	Description	Most Affected Group	Source(s)
Physical assault	Interpersonal violence or fights	Young adult males, urban areas	1, 2
Road traffic accidents	Motor vehicle or motorcycle crashes	All ages, often urban	1, 2, 4
Sports injuries	Contact or collision during sports	Young adults, athletes	4
Falls	Accidental falls or trips	Older adults, children	2, 4
Domestic accidents	Injuries at home	Rural areas, elderly	2
Animal attacks	Bites, kicks from animals	Rural populations	2

Table 3: Common Causes of Nasal Fractures

Interpersonal Violence

Physical assault is the leading cause of nasal fractures in many studies, particularly among young adult males living in urban environments 1, 2. Fistfights, altercations, and intentional blows to the face account for the majority of hospital presentations with a broken nose.

Road Traffic Accidents

Vehicle collisions—whether involving cars, motorcycles, or bicycles—are another major cause. These injuries often result in more severe or complex fractures and may be accompanied by other facial injuries 1, 2, 4.

Sports Injuries

Contact sports (such as boxing, martial arts, football, and hockey) pose a significant risk, especially for young adults and athletes. Protective gear can reduce but not eliminate this risk 4.

Falls and Domestic Accidents

Accidental falls, particularly among children or the elderly, can lead to nasal fractures. In rural settings, domestic accidents (like slipping on stairs or in the bathroom) and even animal attacks (being kicked or bitten) are notable contributors 2.

Sociodemographic Factors

• Gender and age: Males, especially those aged 20–39, are at highest risk 1, 2.
• Education and environment: Lower education levels and urban living are associated with higher rates of nasal fracture due to violence, while rural populations more often experience domestic or animal-related injuries 2.

Treatment of Broken Nose

Proper treatment of a broken nose is crucial for restoring function, minimizing deformity, and preventing complications. The choice of treatment depends on the fracture type, severity, and timing of presentation.

Treatment	Description	Indication/Outcome	Source(s)
Closed reduction	Manual realignment of nasal bones	Simple fractures, most common method	4, 7
Septoplasty	Surgery to repair septum	Septal involvement, obstruction	2, 4, 6, 7
Open reduction	Surgical exposure and fixation	Severe, open, or complex fractures	4, 7
Observation	Monitoring without intervention	Nondisplaced/minor fractures	4
Hematoma drainage	Removal of blood collection	Septal hematoma presence	2, 6, 7
Advanced surgery	Osteotomies, cartilage grafts, rhinoplasty	Severe deformity, failed reductions	5, 6

Table 4: Treatment Options for Broken Nose

Initial Assessment and Timing

Assessment begins with a detailed history and physical exam. Timing is important:

• Immediate treatment is needed for septal hematomas (to prevent cartilage death) and open fractures (to prevent infection).
• Most simple fractures are best treated within 7–10 days of injury, once swelling subsides but before bones set 4, 7.

Closed Reduction

This is the first-line treatment for most uncomplicated nasal fractures. The bones are manually repositioned, usually under local anesthesia. Closed reduction is effective for many patients, but perfect cosmetic outcomes are not guaranteed; deformities may persist if the septum is involved 4, 7.

Septoplasty

When the septum is fractured or displaced—leading to obstruction or risk of deformity—septoplasty (surgical correction of the septum) is indicated. Studies show combining closed reduction with septoplasty yields better outcomes and fewer complications than closed reduction alone 2, 4, 6, 7.

Open Reduction and Advanced Techniques

Severe, open, or comminuted fractures, and those with multiple facial bone involvement, may require open reduction (surgical exposure and fixation of bones) or even advanced surgeries such as osteotomies or cartilage grafts. These approaches are particularly important for restoring appearance and function in complex cases 5, 6.

Hematoma Drainage

Septal hematomas must be drained promptly to prevent cartilage damage and future deformity. Failure to treat can result in chronic obstruction or "saddle nose" deformity 2, 6, 7.

Observation and Follow-Up

Minor, nondisplaced fractures may be managed with observation, ice, pain medication, and close monitoring. Follow-up is essential to identify late complications such as malunion or persistent nasal obstruction 4.

Conclusion

A broken nose is a common facial injury with a wide spectrum of causes, symptoms, and treatments. Early recognition and appropriate management are vital for the best possible outcome. Here’s what you should remember:

• Symptoms include pain, swelling, bleeding, deformity, bruising, and nasal obstruction.
• Types range from nondisplaced and closed fractures to complex, open, or septal-involving injuries.
• Causes are dominated by physical assault and road traffic accidents, with sports, falls, and domestic incidents also contributing.
• Treatment options include closed reduction, septoplasty, open reduction, drainage of hematomas, and, in complex cases, advanced surgical techniques.

In summary:

• Broken noses are most common in young men and often result from violence or accidents 1, 2.
• Early diagnosis and the right treatment prevent complications and improve long-term outcomes 4, 7.
• Septal injuries are frequent—addressing them during initial treatment reduces the risk of chronic problems 2, 4, 6, 7.
• Regular follow-up and patient education are key to minimizing complications and ensuring full recovery.

Whether you’re a patient, clinician, or simply curious, knowing the essentials of broken nose management can make all the difference in addressing this prevalent injury.