How do i know if my child has a broken nose

Nasal Fracture in Children | Cedars-Sinai

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

What is a nasal fracture in children?

A nasal fracture is a break in one or more of the bones of the nose, caused by trauma. It’s also called a broken nose.

There are 2 nasal bones side by side in the nose. These bones form the bridge of the nose. They help support the upper part of the nose. They also help support the cartilage that forms the lower part of the nose.

A nasal fracture is a break in one of the nasal bones or in one or more of the bones that make up your nasal septum. The septum separates the left and right sides of your nose. It's made of cartilage and parts of several other nasal bones. These are the ethmoid bone, the vomer bone, the maxillary bone, and the palatine bone.

Nasal fractures are more common in adults than in children. Children’s nasal bones are harder to fracture. Nasal fracture is fairly uncommon in young children because they don't take part in the activities that can cause a nasal fracture. The risk increases with age. More boys than girls get nasal fractures. The nasal bone is one of the most commonly fractured bones of the face. The lower part of the nasal bone is thinner than the upper part and breaks more easily.

What causes a nasal fracture in a child?

Trauma to the nose causes nasal fracture. This might come from various sources such as:

Falls
Contact sports
Weight lifting
Automobile injuries
Child abuse

Most nasal trauma doesn't cause nasal fracture. Many children have other injuries to the nose, like deviation of the septum.

What are the symptoms of a nasal fracture in a child?

Symptoms of a nasal fracture might include:

Nosebleed
Swelling
Bruising of the nose
Bruising under the eye
Tenderness when touching the nose
Crunching sound when touching the nose
Trouble breathing out of the nose
Deformity of the nose

Usually, the injury to the nose is obvious.

How is a nasal fracture diagnosed in a child?

Your child’s healthcare provider will ask about your child's health history, and about the details of the trauma. Your child will also need a thorough medical exam. This will include both an internal and external exam of the nose. Because nasal fracture often happens with other injury, your child will need a thorough exam assessing other possible areas of injury, like the eyes and teeth.

Plain X-rays don't usually aid in diagnosis. Your child may need another type of imaging such as CT scan to provide more information about the damage.

A primary care healthcare provider, emergency room healthcare provider, or pediatrician (healthcare provider who specializes in children’s healthcare) often makes the first diagnosis. However, most children need to see an ear, nose, and throat healthcare provider (otolaryngologist) for treatment.

How is a nasal fracture treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Children should sit upright for a time after the injury, to help reduce swelling and pooling of blood in the nose. Initial treatment might include pain medicines and ice.

Some children with severe injuries need to see an ear, nose, and throat healthcare provider immediately. Others will need to see an ear, nose, and throat healthcare provider after a few days. The delay allows the swelling to go down, so the healthcare provider can evaluate and recommend further steps.

Many children need “reduction” of the nasal fracture as part of their treatment. This just means that a healthcare provider needs to realign the bones, if they are out of place. Your child might need this right away or later at a follow-up appointment. Your healthcare provider might do this by physically moving the bones back into place (“closed reduction”). Less commonly, surgery is needed (“open reduction”). Because this can be painful, healthcare providers usually do this when the child is asleep under general anesthesia. After reduction, the nose usually needs a splint.

After the reduction, your child’s nose may not look exactly the way it did before. Rhinoplasty surgery (nose surgery) may help restore a more cosmetic appearance.

If your child’s nasal fracture is more severe, he or she might need a more complicated surgery immediately after the injury. Septorhinoplasty can help restore the cosmetic appearance of the nose, as well as restoring a displaced nasal septum and blocked nasal airway.

What are possible complications of a nasal fracture in a child?

Nasal fracture in children sometimes results in complications, though your healthcare team will work hard to prevent these. Your child’s risk for complications may vary according to age and the extent of injury. Some possible complications include:

Septal abscess
Septal hematoma
Severe nosebleed
Infection of the brain or tissues around the brain
Tear duct obstruction
Abnormal connection between the nasal cavity and the mouth
Underdevelopment of the maxillary bone (making the middle of the face look sunken)
Cosmetic imperfections

These complications often need additional treatment, like antibiotics for a septal abscess, or surgical drainage of a septal hematoma. In infants, nasal fracture can also cause trouble breathing because infants can't breathe through their mouths. These children need immediate treatment.

How can I help my child live with a nasal fracture?

After a nasal fracture, the nose needs time to heal. The nose is easy to reinjure during this time. For this reason, most healthcare providers recommend that children stay away from all sports for at least 2 weeks. Your child needs to avoid contact sports (like football or wrestling) for at least 6 weeks.

When should I call my child's healthcare provider?

Call the healthcare provider if any your child’s nose continues to bleed, if he or she has a fever or chills, or shows confusion or unconsciousness.

Key points about nasal fracture in children

A nasal fracture is a break in one or more of the bones of the nose, caused by trauma.

Falls, sports, and automobile accidents are common causes of nasal fracture.
Your child may need to have his or her nose put back in alignment, usually under general anesthesia.
Specific treatment for nasal fracture varies according to the nature of the injury, how long ago it happened, and other associated injuries.
Your child may need additional surgery to help restore the nose’s cosmetic appearance.
For several weeks after the injury, it's important to be especially careful not to reinjure the nose.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

Understanding Broken Nose (Nasal Fracture) in Children

A nasal fracture is a break in one or more of the bones of the nose. It’s also called a broken nose. Nasal fractures are more common in adults than in children. Children’s nasal bones are harder to fracture. But the nasal bone is one of the most commonly fractured bones of the face. The lower part of the nasal bone is thinner than the upper part and breaks more easily. In babies, nasal fracture can cause trouble breathing. This is because babies can’t breathe through their mouths. A baby with nasal fracture may need emergency treatment.

The bones of the nose

Two nasal bones lie side by side in the nose. These bones form the bridge of the nose. They help support the upper part of the nose. They also help support the cartilage that forms the lower part of the nose. The septum separates the left and right sides of your nose. It's made of cartilage and parts of several other nasal bones. These are known as the ethmoid bone, the vomer bone, the maxillary bone, and the palatine bone. A nasal fracture is a break in one of the nasal bones or in one or more of the bones that make up the nasal septum.

What causes a nasal fracture?

Injury to the nose causes nasal fracture. This can happen during:

A fall
Contact sports
Weightlifting
Automobile accident
Child abuse

Most nasal injury doesn't cause nasal fracture.

What are the symptoms of a nasal fracture?

Symptoms of a nasal fracture in your child may include:

Nosebleed
Swelling
Bruising of the nose
Bruising under the eye
Pain when touching the nose
Crunching sound when touching the nose
Trouble breathing out of the nose
Change in shape of the nose

How is a nasal fracture diagnosed?

The healthcare provider will ask about your child’s health history. They will ask about the event that caused the injury. Your child will have a physical exam. This will include both an internal and external exam of the nose. Nasal fracture often occurs with other injuries, so your child’s eyes and teeth may also be examined. Your child may need an imaging test, such as an X-ray or a CT scan. These are painless tests that can create detailed images of the injured area.

Injury of the nose in a child

The nose is the most protruding, relief and noticeable part of the face. Therefore, in the structure of traumatic injuries of the ENT organs, the trauma of the nose occupies a leading position.

The causes of a nose injury in a child are very diverse: domestic, criminal, sports, combat, auto injury, etc. Serious damage to the nose can occur in the first minutes of life when the baby passes through the birth canal if the mother does not properly manage the birth.

Signs of a nose injury in a child

A fracture of the skeleton of the nose in your child can be suspected if, after the injury, severe nosebleeds are noted, swelling and a change in the shape of the nose appear, the skin of the back of the nose is dissected, a pain symptom is expressed. Alarming symptoms are also bruises around both eyes and liquid sticky discharge from the nose: it is possible that a trauma to the nose is accompanied by a fracture of the base of the skull. The increase in swelling and redness of the nose, accompanied by an increase in body temperature, indicate infection of injured tissues.

Treatment of trauma of the nose

Treatment of traumatic deformities of the nose in children - surgical reduction of displaced fragments of the nasal skeleton under general anesthesia, followed by tamponade of the nose to fix the correct position of the fragments. The best cosmetic results of surgical treatment are observed in the first 10 days after the injury. Later, the fragments begin to grow together in the wrong position and their reduction becomes problematic.

TO	AFTER

Peculiarities of nose injury in children

A feature of childhood nose injury is that, due to the small anatomical dimensions of the nose and rapidly developing traumatic edema, external deformity is hardly noticeable externally. Therefore, after any, even seemingly insignificant bruise of the nose, the child should be shown to the otorhinolaryngologist without delay. In addition, if your child's nose injury was intentionally inflicted by the offender and a trial is planned, then it is necessary to undergo a medical examination of the severity of the injuries. Early examination of the nasal cavity with endoscopic optics and X-ray examination allow timely detection of outwardly hidden damage and timely start of their treatment. Otherwise, with age, during the growth of the damaged skeleton of the nose, its external deformation may develop, and the progressive curvature of the broken nasal septum may completely turn off nasal breathing.

Do not be upset if, for some reason, the surgical treatment of a nasal skeleton fracture that your child needs was not carried out in a timely manner. The children's department of our Center has long developed and successfully uses original methods for correcting deformities of the septum and external nose (rhinoseptoplasty), adapted for children of different ages after a previous injury.

Make an appointment at the reception of our Center to Dr. med. Sciences Rybalkin S.V. you can call: 8(499) 968-69-12.

Signs of a nose fracture in a child and subsequent treatment

Due to the anatomical features of its location, it is the nose that is most susceptible to all kinds of damage. This is especially true for young children, who still have poor control over their movements. A broken nose in a child requires immediate action on the part of the parents. It is very important to respond to the injury in a timely manner and consult a doctor. Otherwise, a life-long and pronounced defect may remain on the face. Subsequently, it can be removed only with the help of a complex surgical operation.

To rule out such a development of the situation, we recommend that you find out what are the signs of a broken nose in a child.

Contents

Symptoms of a fracture
Diagnosis and first steps after a fracture
Treatment of nasal injuries
Possible infection

Symptoms of a fracture

Before naming the symptoms of a fracture, it is important to understand the anatomical structure of the nose before naming the symptoms of a fracture. This organ is made up of cartilage and bone. Cartilage is the building material for the nasal wings, tip and septum of the anterior part of the nose. As for the bone tissue, this is the building material for the back of the septum of the organ and the back of the nose.

The symptoms, as well as the severity of the damage to the nose, will directly depend on many factors. In particular, the main role in this is played by the impact force and the object that caused the injury. The size of the organ is also taken into account, since a large nose is more prone to injury than a small neat nose.

So, the symptoms of a fracture will be as follows:

The child may experience a severe state of shock. In some cases, children may even lose consciousness.
Severe nausea, vomiting, disorientation and dizziness often accompany the injury.
A broken nose may be diagnosed as bleeding. In some cases, it is characterized by profusion, in others - by moderation (such bleeding is called spotting).
In the process of palpation (palpation of the damaged area) there are intense pain sensations. Even light pressure can cause severe pain. If the child is small, then attempts to feel the damaged nose will lead to resistance on his part, crying and screaming.
Often during palpation, the mobility of the nasal septum is clearly visible.
Another symptom of a fracture is occasional mucous discharge from the nose.
A broken nose always swells up and the tissues around it swell. When using cold compresses, the swelling disappears only after two or more days. Without a compress, swelling will be clearly visible from five to seven days.
Bruising should be noted separately. As a rule, with a fracture, they occur in the areas around the eyes and on the cheekbones.
A severe injury is always accompanied by a violation of the integrity of the skin.
Another clearly visible manifestation of the injury is the deformity of the shape of the nose.
The accumulation of blood under the nasal mucosa makes it difficult to breathe and leads to the appearance of a hematoma in the nasal septum. It is impossible to eliminate it with improvised means. This requires surgical intervention.
When the nose is broken, tears often flow profusely.
If an open fracture occurs, fragments of bones are visible in the damaged tissues.

Diagnosis and first steps after a fracture

Before starting treatment procedures, it is necessary to make a correct diagnosis. Acute pain in the injured area and profuse bleeding are not reliable signs of a fracture. The final diagnosis is made by the doctor, guided by the data obtained on the basis of diagnostic measures. Diagnosis will eliminate the possibility of a simple bruise, which is also often accompanied by blood loss, severe pain and even loss of consciousness.

The child is examined by an otolaryngologist, then an x-ray of the facial area is ordered. Endoscopy can be used as an additional diagnostic method. In addition to the otolaryngologist, other specialists are involved in establishing an accurate diagnosis, in particular, an oculist and a neurologist. A visual examination makes it possible to:

An x-ray will show if there is a fracture and which bones/cartilages are most affected. This is one of the most effective diagnostic techniques.

What to do after a child is injured? First of all, you need to calm the baby. Next, we stop the bleeding - the head should be tilted slightly forward so that the blood does not enter the nasopharynx. To prevent severe swelling, apply a cold compress to the damaged area.

There should be no quick or abrupt movements. It is extremely important to completely eliminate the possibility of sneezing and blowing your nose. Otherwise, bleeding may become more active. And, of course, after all these actions, you should call a doctor.

Treatment of nasal injuries

As a rule, minor injuries are treated at home under direct medical supervision. However, a severe injury (up to a nose fracture) should be treated in a hospital. In particular, rehabilitation in the hospital is carried out in the following cases:

severe deformity of the nasal septum;
eye damage;
brain dysfunction;
damage to the maxillary sinuses;
profuse unstoppable bleeding.

As for the medical care itself, it can be of a medical nature, or it can be a surgical intervention. To stop the bleeding, special medications are prescribed. Treatment is supplemented by taking sedatives, painkillers, as well as antispasmodics. If an open fracture is detected, then it becomes advisable to take antibiotics, which can completely eliminate the source of infection. Light damage to the skin without violating the integrity of the bones is treated with antiseptic agents.

As for serious injuries, when the nasal septum is damaged or displaced, professional help is definitely indispensable. It is necessary to return the bones to the correct position as soon as possible, and then fix them so that they subsequently grow together correctly.

It is not worth postponing such a procedure, it is recommended to do it on the first day after the injury (however, only if there is no concussion). If there is concussion, alignment and fixation of the bones occurs after about 7 days. Another week the child is under strict medical supervision.

Possible infection

The above symptoms of a nose fracture can be supplemented by others that indicate infection. In nasal trauma, infection can occur almost instantly. This is fraught with dangerous complications.

To identify the presence of infection, look for the following characteristic signs:

well-marked redness of the injured facial area;
swelling of soft tissues and painful sensations of varying intensity;
rapid increase in body temperature for no apparent reason;
the appearance of abscess symptoms, in particular - softening of tissues and the appearance of purulent formations.

The last sign is the most alarming, as it is fraught with great danger. Often it provokes such a complication as a brain abscess. As a rule, such a pathology occurs due to infection through the blood or a breakthrough of purulent neoplasms in damaged areas.